Colles Fracture Made Simple: Exam Essentials

Hello fellow students! Ever feel that sense of panic when a wrist X-ray pops up and you're asked to describe what you see? I have! Many times. Especially with the wrist, there's so many things that could be happening. Especially, with all the delicate little bones involved. Here’s some good news: You can nail one step at a time, starting with the Colles fracture.

I’ve spent far too long reading, for the information not to stay in my brain. Making countless amounts of notes that just clutter up my desktop. So I’ve figured let's put it all in one place, to not only help myself before exams, but hopefully a fellow student or 2 as well. So save yourself time and consider this as your cheat sheet for understanding the Colles fracture and ace your exam and clinical practice.

Disclaimer: I’m a radiography student sharing my revision notes to help you get started—think of this as a study nudge, not medical advice! I’m not a licensed professional (yet!), so always consult a qualified radiographer or doctor for clinical decisions. Use these notes as a springboard for your own study—let’s make wrists your exam superpower together!

FOOSH!

Fall onto an outstretched hand

Ok, meet the patient Jane. She’s, going about her day, all of a sudden she has a bit of a wobble, takes a tumble and starts to fall forward. Her hand shoots out instinctively to try and stop the fall. Bam! Full force, palm down, wrist bent backwards, the distal end of the radius takes the brunt of the fall.

And that, is the mechanism of injury (MOI) for how a Colles fracture occurs.

The term you will see on the request is FOOSH - fall onto outstretched hand. 

Impacting the force up the arm and fracturing at the distal radius. 

How Will The Patient Present?

So what are the signs and symptoms that it might be a Colles fracture, before you have even looked at the X-Ray? 

• The “Dinner Fork” deformity: This is the classic sign, imagine holding a dinner fork upside down. Can you see the resemblance? The wrist bent backwards noticeably and unnaturally.

• Swelling: The wrist area will likely be puffy and tender, hot to touch. Thats if the patient will allow you near it!

• Pain: The patient will likely be unwilling to move their wrist because of the pain!

Recognising these clues when meeting the patient can give you a strong indication that you are dealing with a Colles Fracture.

What To Look For On The X-Ray?

Ok, the reason why we are here is to see what a Colles fracture looks like on an X-ray.

• Dorsal Tilt: REMEMBER THIS. Looking at the lateral radiograph. The distal end of the radius will be angled backwards. We’re often talking about an angle of 15-20 degrees.

• Shortening: Compared to a normal wrist, the adius might look a bit squashed or shorter. The fracture can cause the bone fragments to overlap slightly.

• Jagged Break Line: The actual fracture line across the distal radius won't be a clean break. It's usually irregular and jagged.

Quick Quiz: Test Your Colles Fracture Knowledge!

Let's do a quick check-in. See if you can answer these:

1. What's the most common way a Colles fracture happens? (Think FOOSH!)

2. Name two things you might see or feel when assessing a patient with a Colles fracture. (Dinner fork, swelling, tenderness!)

3. What's the main thing you'll look for on the lateral X-ray? (Dorsal tilt!)

4. Which bone is usually broken in a Colles fracture? (The distal radius!)

5. Why do we call it a "dinner fork" deformity? (Think about the shape!)

My Revision Secret Weapon: The Colles Cheat Sheet 

To really get this to stick in my head, I have done 2 things. 1 is to try and teach the subject to you. I hope you have found this somewhat useful. 2. Is to create visual aids, I find sketching makes a HUGE difference for me. Just something that forces you to think a bit more creatively than just writing notes. Check out my Colles fracture poster below (feel free to screenshot or copy it).

However, I highly recommend you make your own visual aid, whether it be a poster or, mind map. These are great tools to solidify your understanding and to test yourself on.

Your Next Steps

So there you have it – the essentials of the Colles fracture, broken down in a way that hopefully makes sense and sticks! Remember, practice makes perfect. The more X-rays you look at, the more confident you'll become in spotting these key features.

If you found this helpful and want to dive deeper into other wrist topics, let me know in the comments below!