Fractures (Colles and Scaphoid)

What is it?

Colles fracture:

  • This is a break in the radius (one of the bones of the forearm) near the wrist
  • It usually occurs after a fall onto an outstretched hand
  • It is common among those with osteoporosis due to decreased bone density
  • It is also common among the younger population often due to high impact trauma e.g. contact sports, skiing, horse riding

Scaphoid fracture:

  • This is a break of the scaphoid (a small bone in the wrist located near the thumb)
  • It can occur due to trauma such as falling onto an outstretched hand or a direct blow to the area
  • Stress fractures can occasionally occur in the scaphoid as well- this is more commonly seen in high level athletes e.g. gymnasts and shot-putters

Typical Symptoms/features

Colles fracture:

  • Pain at the wrist following trauma
  • Deformity of the wrist
  • Pain with movements
  • Once fracture has healed:
    • may have stiffness and reduced range of movement of the wrist
    • Loss of strength e.g. picking up kettle, turning keys
    • Pain when weight-bearing through the wrist

Scaphoid fracture:

  • Specific pain over the scaphoid near the base of the thumb
  • May have swelling or bruising

Imaging & Management

Most Colles fractures:

  • Will be picked up through A+E by an X-ray. Initial management generally includes plaster casting or surgical fixation depending on the level of displacement
  • Future X-rays may be repeated in fracture clinic to monitor healing

Scaphoid fractures:

  • Are often not identified on X-ray right away after trauma
  • If a scaphoid fracture is suspected, further imaging may be indicated such as CT or MRI
  • Orthopaedic management generally includes immobilisation and/or surgery

Physiotherapy Management:

  • Can be commenced once cast is removed or when cleared by orthopaedics
  • To include range of movement and gradual strengthening programme