Colles Fracture: Rehabilitation and Recovery Time

You’ve got a Colles fracture, you’ve never really heard of it before, so you’re looking for info to know what to expect?

In this article, I’ve tried to bring together all the information that might be useful to people who have recently been diagnosed with this type of wrist fracture.

Happy reading! And don’t forget to comment if you have any comments or questions…

♻️ Last update: 20 January 2024.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of interest is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

What exactly is a Colles fracture?

A Colles fracture belongs to the broad category of wrist fractures.

This fracture affects one of the 2 bones of the forearm: the radius. This is the bone on the side of the thumb.

When you have a Colles fracture, you’ve broken the radius at its lower end (= at the bottom), at wrist level.

Fractures of this part of the radius are very common: up to 1 in 6 people treated in an emergency hospital for a fracture have this type of fracture, all parts of the body combined.

And like any fracture, it can be of different types:

• extra-articular fracture: this is the most common type of Colles fracture. The broken part is located just above the wrist joint, and does not directly affect the joint, which is a good thing: recovery is often better and faster;
• articular fracture: conversely, the fracture line also affects the joint;
• displaced or non-displaced fracture. When the fracture is displaced, the bone fragments are far apart. As a result, it generally takes longer to heal.

These fractures occur more often in children and adolescents (under 19), and in “elderly” people (over 50). They often occur when you fall with your hand in dorsiflexion:

Sources: Summers 2023

Why is it called that?

This fracture is known as the Colles fracture (especially in the French-speaking world 🐓 ) in reference to two French physicians, Auguste-François Pouteau and Abraham Colles, who both described this type of fracture independently in the 18th and 19th centuries respectively.

In international scientific studies, the term “fracture of the distal end of the radius” or “Colles’ fracture” is often used rather than “Pouteau-Colles fracture”.

It’s also known as distal fracture with dorsal angulation.

The Colles is the most common fracture of the distal end of the radius (Corsino 2023).

How can you be sure it’s a Colles fracture?

The diagnosis of a Colles fracture is based on :

• the presence or absence of certain symptoms;
• the event that triggered the trauma: how you fell;
• anX-ray to confirm whether or not a bone is broken.

Your doctor will look for the following signs:

• wrist pain and tenderness to palpation;
• sometimes a dorsiflexion deformity when the fracture is displaced;
• bruising and swelling;
• reduced range of motion.

Your doctor will also check your pulse, and check that you have good sensitivity and motor skills in your fingers and wrist (if possible), to identify any other lesions: nerve or vascular, in addition to the bone lesion.

The diagnosis of a Colles fracture is best made by X-ray . And sometimes, a CT or MRI scan, especially in the case of surgery or other associated lesions.

How is a Colles fracture treated?

Two main types of treatment are possible, depending on the type of fracture, the person’s general condition and the practice habits of the teams involved at the time of diagnosis:

• conservative” orthopaedic treatment: immobilization of the wrist with a splint or plaster/resin;
• surgical treatment: operation with fitting of hardware. And sometimes, immobilization by plaster cast or splint also behind.

In both cases, you’ll often need physiotherapy to help you regain the same mobility and strength in your wrist as before.

In people over 65, there is no difference in functional outcome whether or not surgery is performed: people recover in the same way in general (Summers 2023).

Splint, cast: conservative treatment

If the fracture is displaced, it is manually reduced by a doctor or surgeon. This is a manipulative procedure designed to realign the bone segments correctly. This is done with a small amount of anaesthetic or gas to relieve or avoid pain.

Afterwards, you are often put in a plaster cast.

After a few weeks, we take a follow-up X-ray and decide whether or not to remove the cast.

The cast is often kept on for 6 weeks in adults, and often less in children. Until consolidation is well under way.

After the cast, a splint is sometimes prescribed as a transitional measure. This can relieve pain and discomfort, for example at night. Or during daytime rest periods.

Surgery: surgical treatment

If the fracture is too displaced, an operation is often scheduled. Often immediately, sometimes after a few weeks, to see whether or not consolidation has taken place without surgery.

Different techniques are used. In your operative report, you can find precise information on the type of equipment you have.
These are often :

• pins (percutaneous pinning), which can be inserted arthroscopically,
• or plates (internal fixing) when opening,
• external mounting,
• or wire fastening.

Rehabilitation, physiotherapy

Physiotherapy is often prescribed after a Colles fracture, especially for adults. Most often after the immobilization period.

The aim of physiotherapy sessions is to :

• answer your questions and reassure you about your progress;
• help you regain good wrist mobility so you can resume all the activities you want.

Some studies have compared the progress of people who undergo physiotherapy in an office or center after a wrist fracture, versus those who do exercises on their own at home.Recovery is similar in these 2 groups.

Source: Cochrane 2015

How long does it take to heal from a Colles fracture?

The total healing time for a Colles fracture is a few months (often 2 to 46 months). Of course, it all depends on what you mean by “total healing”. Personally, I mean how long it will probably take before you can“do it all over again“.

Here are some of the usual delays I see in my patients after a Colles fracture, whether operated or not:

Step	Healing time (usual)
You have much less pain	A few days to a few weeks
Bone healing is complete or well under way	6 weeks to 3 months (much less in children)
Swelling and bruising disappear	A few days to a few weeks
No need for downtime	6 weeks to 3 months
You can gradually use your hand to eat and dress yourself.	A few weeks to a few months
You can start carrying weights (bags, dumbbells) with a fractured wrist.	2 to 5 months
You can resume all your previous physical and sporting activities	3 to 8 months

Time for consolidation?

The healing time of a Colles fracture varies according to several factors, such as the severity of the fracture, the person’s general health and the type of treatment used.

In general, bone consolidation can take around 6 to 8 weeks, with great variability!

Length of time off work?

It’s up to your doctor to determine how long you should work, depending of course on your state of health, your professional activity and your own opinion on the matter.

In France, the Assurance Maladie (French health insurance scheme) specifies standard recommendation times depending on the type of injury or operation, but doctors are free to follow them or not.

Here are the times she gives for fractures of the lower end of the radius (thus Colles):

• 7 days for sedentary work, whether orthopaedic/conservative or surgical treatment;
• between 10 and 84 days, depending on the physical intensity of your non-sedentary work.

When can you drive your car again?

Many of my patients ask me when they are allowed to drive after their wrist fracture.

Let’s be clear about what we mean by “right”:

1. there’s the legal, insurance aspect: when you can drive without having any problems of this kind;
2. the risk of accidents for oneself and others;
3. the risk of complications and delayed consolidation.

In France, the Highway Code determines when you are legally entitled to drive and when you are not:

All vehicle drivers must always be in a condition and position to carry out all maneuvers conveniently and without delay.

article R. 412-6

So it’s up to you to assess whether or not you’re fit to drive. Here’s what I recommend to my patients to take into account both the legal and safety aspects:

• if you don’t feel like driving, simply wait to feel before considering taking over;
• if you feel like taking over

  :Polylang placeholder do not modify

Some people decide to resume driving in the days following a Colles fracture, while many wait until they no longer have a cast and are more mobile at the wrist.

Complications, sequelae or long-term consequences of a Colles fracture?

The vast majority of people who suffer a Colles fracture make a full recovery without major complications. Complications are more the exception than the rule, and affect only a small percentage of patients! I mention them anyway because I know that some people want to know what can happen.

Two complications that occur in a cast after a Colles fracture (Summers 2023):

• carpal tunnel syndrome;
• rupture of the long extensor tendon of the thumb.

In the event of surgery, these are the complications that may arise (in 15% of cases; in 5% of cases, a further operation is required):

• infection of the scar or operated area;
• nerve damage;
• displacement of a screw in the wrist joint ;
• tendon rupture.

As for long-term after-effects and consequences, bear in mind that Colles fractures are very common, and that most people recover without any after-effects.

When there are after-effects, they are mainly wrist stiffness (not necessarily a problem in everyday life) orearly osteoarthritis. These may be linked to non-union fracture.

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Do you have an experience to share or comments to make? See you in comments!