A Broken Wrist After a Fall: Distal Radius (Colles) Fracture

A Colles fracture is a break at the lower end of the radius, the larger forearm bone, where the broken end tilts backwards and gives the wrist a "dinner fork" shape. It usually follows a fall onto an outstretched hand. Many breaks heal in a cast. When the bone is out of position or unstable, I fix it with a small metal plate (a volar locking plate), which often means no cast afterwards. Desk workers can often return within days of surgery; driving takes about 6 weeks.

Written and reviewed by Mr Dafydd (Taff) Edwards FRCS(Tr&Ortho), Consultant Hand, Wrist and Elbow Surgeon, Cleveland Clinic London. Last reviewed: 31/10/26.

What is a Colles fracture?

The radius is the larger of the two bones in the forearm. A distal radius fracture is a break near its lower end, where it forms part of the wrist joint. In a Colles fracture, the broken end tilts backwards towards the back of the hand, which gives the wrist its "dinner fork" shape. It is one of the commonest fractures seen in emergency departments.

A fracture is the same as a break.

How does it happen?

Most follow a fall onto an outstretched hand. In younger adults the cause is often a higher-energy injury, such as sport, cycling, skiing or a road accident. In older adults a simple trip can be enough, especially if the bones are thinner (osteoporosis). If you break your wrist in a low-energy fall, ask about a bone health check.

What are the symptoms?

Pain and swelling at the wrist straight after a fall
A bent or "dinner fork" shape to the wrist
Bruising, and pain when you try to move the wrist or grip

When is it urgent?

Go to an emergency department the same day for an X-ray if your wrist is painful and swollen after a fall. Be seen straight away if:
Your fingers are numb, tingling or cold
The skin over the break is broken
The wrist is badly bent
You cannot move your fingers
Numbness after a wrist fracture can mean the nerve at the wrist is being squeezed (acute carpal tunnel syndrome), which needs urgent treatment.

When should I see a hand surgeon?

National guidance sets clear timings: fracture clinic review within 72 hours, and if surgery is needed, within 72 hours for a break into the joint and within 7 days for other breaks. In practice, surgery within the first 2 weeks still gives excellent results. See a hand surgeon if the break enters the joint, the wrist is badly bent, or the bone slips after it was set.

Do I need surgery for a broken wrist?

Not always. The choice depends on how far the bone has moved, whether the break enters the joint, how stable it is, and what you need your wrist for.

A cast or splint. A stable break in a good position heals in a cast or a removable splint. National guidance suggests considering cast removal and gentle movement from about 4 weeks for many breaks.
Setting the bone (manipulation). If the bone has tilted, it can be pushed back into line under anaesthetic and held in a moulded cast. In the UK DRAFFT2 trial of about 500 adults, a moulded cast gave similar results at 1 year to surgery with wires, but about 1 in 8 people needed surgery later because the bone slipped. You will have a check X-ray at 1 to 2 weeks to catch this early.
Surgery. If the break enters the joint, cannot be held in a good position, or slips after it was set, surgery is the better option. National guidance supports either wires or a plate, depending on the pattern of the break.

What does plate fixation involve?

When a fracture needs fixing, I use a volar locking plate: a small, low-profile metal plate placed on the palm side of the wrist and held with screws. It holds the bone in the right position while it heals. Because the plate makes the wrist stable, many patients do not need a cast afterwards and can start moving the wrist early. The plate is usually left in place.

What if I am over 65?

National standards suggest a cast can be considered for people aged 65 or over when the wrist is not badly bent and there are no nerve problems. Many older adults do well without surgery, but the decision depends on how active you are and how the break looks. This is decided on a case by case basis and age alone should not be used as a reason to offer one treatment or another.

How long is recovery?

After plate fixation:

Cast: often not needed; if it is, 6 weeks
Heavy lifting: avoid for 6 weeks
Driving: about 6 weeks
Desk work: often within 1 to 2 days of surgery, with care (let your workplace know)
Manual or heavy work: 10 to 12 weeks
Full recovery: 3 to 6 months

Hand therapy and the wrist fracture exercises help you regain movement and strength. For more on driving, see Driving after hand surgery.

Frequently asked questions

What is a dinner fork fracture? It is another name for a Colles fracture. The broken end of the radius tilts backwards, so the side of the wrist looks like an upside-down dinner fork.

Can I drive with a broken wrist? Not while you are in a cast. After plate fixation, most people return to driving at about 6 weeks, once they can grip the wheel and make an emergency stop.

Will I need a cast after surgery? Often not. A plate holds the bone firmly, so many people go into a removable splint or bandage and start moving the wrist early. If a cast is needed, it stays on for 6 weeks.

When can I go back to work? Desk workers can often return within 1 to 2 days of surgery, taking care and letting their workplace know. Manual or heavy work usually takes 10 to 12 weeks.

Does the plate need to come out? Usually not. It stays in place unless it causes irritation.

Book a consultation: 020 3423 7183 or contact the clinic.

What are the risks?

Stiffness, and a weaker grip for some months
The bone slipping in a cast, which may then need surgery (about 1 in 8 in the DRAFFT2 trial)
After surgery: infection, irritation of a tendon by the plate or screws, or numbness from pressure on a nerve
Complex regional pain syndrome, a rare cause of prolonged pain and swelling
Arthritis in the wrist later, if the joint surface was damaged

Sources

Fractures (non-complex): assessment and management (NG38), NICE, 2016 (updated June 2025): manipulation and cast, wires or plate, surgery within 72 hours (joint) or 7 days.
BOAST: Management of distal radial fractures, British Orthopaedic Association, December 2017: fracture clinic within 72 hours, cast removal from 4 weeks, check X-ray at 1 to 2 weeks, cast option at 65 or over, bone health.
Wrist fractures: plaster casts are a safe, cost-effective treatment (DRAFFT2), NIHR summary of the UK DRAFFT2 trial, BMJ 2022: cast versus wires, about 1 in 8 casts needing later surgery.
Recovery timings: Mr Edwards' own practice.