Snapshot A 72-year-old woman trips and falls on her outstretched right hand. She experiences immediate pain and swelling over her right wrist. On exam, she has a dinner-fork deformity of the wrist and exquisite pain with passive motion. A radiograph is shown, which reveals a dorsally angulated distal radius fracture. Introduction Clinical definition forearm fracture of the distal end of the radius considered 1 of 3 common "fragility fractures" associated with osteoporosis login to view 1 more bullet "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures Epidemiology Incidence most common forearm fracture Demographics bimodal distribution younger patients login to view 3 more bullets elderly patients login to view 3 more bullets Risk factors osteoporosis other fragility fractures (vertebral compression fractures and femoral neck fractures) are predictive of subsequent fractures Etiology Fall on outstretched hand Pathoanatomy normal anatomy radius and ulna are two bones of the forearm radius widens in the distal forearm while the ulna narrows distally, the radius articulates with 3 bones login to view 3 more bullets fracture location most fractures occur at distal radial metaphysis can be login to view 3 more bullets Associated conditions distal radioulnar joint (DRUJ) injury radial styloid fracture ligamentous injuries triangular fibrocartilage complex (TFCC) injury scapholunate ligament injury Presentation Symptoms severe wrist pain worse with passive motion Physical exam swelling ecchymosis tenderness to palpation limited range of motion deformity corresponding to fracture angulation and displacement compartment syndrome should be carefully ruled out in forearm fractures Imaging Radiography indications always indicated if fracture is suspected findings fracture fragment through distal radial metaphysis eponymous fractures login to view 6 more bullets Computerized tomography (CT) scan indications suspicion for intra-articular fracture highly comminuted fractures to better discern fracture pattern findings can better demonstrate extent of intra-articular involvement and individual fracture fragments Magnetic resonance imaging (MRI) scan indication suspicion for associated ligamentous injuries findings TFCC tear scapholunate ligament tear Differential Scaphoid fracture tenderness will be localized to the thenar snuffbox more than the distal radius radiographs will be normal or show a fracture line in the scaphoid DRUJ dislocation radiographs will demonstrate radioulnar instability Treatment Nonoperative closed reduction followed by immobilization indication login to view 1 more bullet Operative open reduction and internal fixation indications login to view 4 more bullets Complications Median nerve neuropathy acute carpal tunnel syndrome Extensor pollicis longus rupture Malunion or nonunion Prognosis Favorable well-aligned anatomic reduction Negative associated neurovascular injuries fracture shortening on pre-reduction radiographs osteoporotic bone old age