Snapshot A 61-year-old woman presents to the emergency room complaining of left wrist pain after falling on her outstretched hand. Her medical history is notable for diabetes and osteoporosis. On exam, her left wrist is swollen and tender to palpation. She is unable to flex or extend her wrist due to pain. 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 femoral neck fractures "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures Epidemiology incidence most common forearm fracture most common forearm fracture 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 most common forearm fracture Etiology fall on outstretched hand Pathoanatomy normal anatomy radius and ulna are 2 bones of the forearm radius widens in the distal forearm while the ulna narrows distally, the radius articulates with three bones ulna (distal radioulnar joint) scaphoid (radioscaphoid joint) lunate (radiolunate joint) fracture location most fractures occur at distal radial metaphysis and 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 Prognosis favorable well-aligned anatomic reduction negative associated neurovascular injuries fracture shortening on pre-reduction radiographs osteoporotic bone old age Presentation Symptoms severe wrist pain pain with motion Physical exam swelling ecchymosis tenderness to palpation limited range of motion deformity corresponding to fracture angulation and displacement Imaging Radiography indication always indicated if fracture is suspected findings fracture fragment through distal radial metaphysis eponymous fractures Colles fracture dorsally angulated extraarticular distal radius fracture Computerized tomography (CT) scan indications suspicion of intra-articular fracture highly comminuted fractures findings can better demonstrate intra-articular involvment and multiple fracture fragments Magnetic resonance imaging (MRI) scan indications suspicion of associated ligamentous injuries findings TFCC tear scapholunate ligament tear Differential Scaphoid fracture may have snuffbox tenderness without tenderness on distal radius wrist radiographs may be normal DRUJ dislocation wrist radiographs may demonstrate radioulnar widening with no fracture lines Treatment Nonoperative closed reduction and cast immobilization indication most non-comminuted extra-articular fractures Operative open reduction internal fixation (ORIF) indication unstable fractures displaced intra-articular fractures comminuted fractures Complications Median nerve neuropathy acute carpal tunnel syndrome Extensor pollicis longus rupture Malunion or nonunion