A 62-year-old woman falls on an outstretched hand while walking. X-ray shows a fracture of the distal radius with dorsal displacement and angulation of the distal fragment. Which is the most common type of distal radius fracture?

Question

Accepted Answer

D. Colles' fracture. ## Most Common Distal Radius Fracture

**Key Point:** Colles' fracture is the most common type of distal radius fracture, accounting for approximately 90% of all distal radius fractures.

### Defining Features of Colles' Fracture

**High-Yield:** Colles' fracture is characterized by:
1. Fracture of the distal radius (within 2–3 cm of the wrist joint)
2. **Dorsal displacement** and dorsal angulation of the distal fragment
3. Associated ulnar styloid fracture (50–60% of cases)
4. Radial shortening
5. Loss of radial inclination

### Clinical Context

**Clinical Pearl:** Colles' fracture is the classic "dinner fork" deformity on lateral X-ray — the dorsal angulation creates a characteristic silhouette. It typically occurs in elderly patients with osteoporosis following a fall on an outstretched hand (FOOSH injury).

### Comparison with Other Distal Radius Fractures

| Fracture Type | Displacement | Mechanism | Frequency | Associated Injury |
| --- | --- | --- | --- | --- |
| **Colles'** | Dorsal + dorsal angulation | FOOSH in elderly | ~90% | Ulnar styloid fracture |
| **Smith's** | Volar (reverse Colles') | FOOSH with flexed wrist | ~10% | Less common |
| **Barton's** | Intra-articular dorsal or volar | High-energy trauma | Rare | Radiocarpal dislocation |
| **Chauffeur's** | Radial styloid fracture | Direct blow to radial side | Rare | Scaphoid injury |

**Warning:** Do not confuse Colles' fracture (dorsal displacement) with Smith's fracture (volar displacement). The mechanism and patient demographics differ — Smith's is less common and typically occurs in younger patients or with a different injury mechanism.

### Why Colles' is Most Common

**Mnemonic:** **COLLES = Common Older Ligamentous Loss Elderly Styloid** — reflects the typical elderly osteoporotic patient with a simple FOOSH mechanism.

The high frequency reflects:
- Osteoporosis prevalence in elderly women
- Protective reflex to fall on outstretched hand
- Biomechanics of wrist extension during impact

Answer

A. Chauffeur's fracture

Answer

B. Smith's fracture

Answer

C. Barton's fracture

A 62-year-old woman falls on an outstretched hand while walking. X-ray shows a fracture of the distal radius with dorsal displacement and angulation of the distal fragment. Which is the most common type of distal radius fracture?

Explanation

Most Common Distal Radius Fracture

Defining Features of Colles' Fracture

Clinical Context

Comparison with Other Distal Radius Fractures

Why Colles' is Most Common

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Fracture Type	Displacement	Mechanism	Frequency	Associated Injury
Colles'	Dorsal + dorsal angulation	FOOSH in elderly	~90%	Ulnar styloid fracture
Smith's	Volar (reverse Colles')	FOOSH with flexed wrist	~10%	Less common
Barton's	Intra-articular dorsal or volar	High-energy trauma	Rare	Radiocarpal dislocation
Chauffeur's	Radial styloid fracture	Direct blow to radial side	Rare	Scaphoid injury