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 login to view 3 more bullets "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 login to view 8 more bullets 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 login to view 3 more bullets fracture location most fractures occur at distal radial metaphysis and can be login to view 3 more bullets 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 login to view 2 more bullets 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 login to view 1 more bullet Operative open reduction internal fixation (ORIF) indication login to view 3 more bullets Complications Median nerve neuropathy acute carpal tunnel syndrome Extensor pollicis longus rupture Malunion or nonunion