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 other 2 are vertebral compression fractures and femoral neck fractures "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures Epidemiology Incidence most common forearm fracture Demographics bimodal distribution younger patients high energy injuries more likely to be male account for up to 25% of pediatric fractures elderly patients low energy injuries more likely to be female account for up to 20% of adult fractures 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 ulna (distal radioulnar joint) scaphoid (radioscaphoid joint) lunate (radiolunate joint) fracture location most fractures occur at distal radial metaphysis can be extra-articular or intra-articular dorsally or volarly angulated dorsally or volarly displaced 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 Colles fracture dorsally angulated extraarticular distal radius fracture Smith fracture volarly angulated extraarticular distal radius fracture Barton fracture intra-articular fracture involving volar or dorsal lip of distal radius with an associated fracture dislocation of the radiocarpal joint 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 most non-comminuted extra-articular distal radius fractures Operative open reduction and internal fixation indications unstable fractures intra-articular fractures severely displaced fractures post-reduction comminuted fractures 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