What type of distal radius fracture do you have?

By Joseph Sharaya, OTD, OTR/L, CHT · Certified Hand Therapist · Last reviewed September 2026

If you have just broken your wrist, someone has probably handed you a report with a name on it. Colles. Smith. Barton. Intra-articular. Dorsally angulated. This page explains what those words mean, in plain language, so the paperwork stops being a foreign language.

What actually broke

You have two bones in your forearm. The radius runs down the thumb side, the ulna down the pinky side. "Distal" simply means the end nearest your hand. So a distal radius fracture is a break in the thumb-side forearm bone, right where it widens out to meet the wrist.

It is one of the most common fractures people have^4,5,7, and the usual story is an ordinary one: a fall, a hand put out to catch yourself, and the whole force of the landing arriving at that widened end of the bone. Clinicians call that a fall onto an outstretched hand, and it is behind most of the patterns below.

That widened end matters, because it is not just bone. It carries the smooth cartilage surface your wrist bones glide on. Whether the break reached that surface is one of the two things every name on your report is describing.

The two questions behind every name

The named patterns look like a list of unrelated surnames, but they are really just the answers to two questions.

First: which way did the broken end move? Toward the back of your hand is called dorsal. Toward your palm is called volar or palmar. A wrist where the end has tipped backward can have a slight step in the profile, a shape clinicians call a dinner fork deformity.¹²

Second: did the fracture line reach the joint surface? If it stopped in the solid bone before the cartilage, it is extra-articular. If it ran all the way into that gliding surface, it is intra-articular.

Two questions, two answers each, and four of the names you might see fall straight out of those answers.

The four named patterns

Colles fracture

The break sits just above the wrist, stops before the joint surface, and the end tips backward toward the back of the hand.^1,12 This is the pattern most people picture when they hear broken wrist, and it is the classic result of landing on an outstretched hand with the wrist bent back.¹² It is named for Abraham Colles, who described it in 1814, eight decades before X-rays existed to confirm it.¹ Colles placed the break about an inch and a half above the wrist joint, which is why the strict definition keeps it out of the joint.¹ In everyday use the name gets applied to almost any distal radius fracture that has tipped backward.¹²

Smith fracture

The same location, the opposite direction. The end tips toward the palm instead of the back of the hand, which is why it is sometimes called a reverse Colles.^3,13 It tends to follow a fall onto a bent-forward wrist or a direct blow to the back of the wrist.¹³ When the volar shift is left in place, the profile it produces is called a garden spade deformity, the counterpart to the dinner fork.¹³ Most Smith fractures are not suited to being set and held in a cast, so they usually go to surgery, most often a plate placed on the palm side.¹³ There is a second reason surgeons care about correcting the volar shift: left displaced, it narrows the entrance to the carpal tunnel and can crowd the nerve that runs through it.¹³

Dorsal Barton fracture

Here the fracture line runs into the joint surface and shears off the back rim of the radius. The important part is what happens next: the wrist bones follow that rim backward, so the joint itself is out of position, not just the bone.¹⁴ That combination is why this pattern is generally treated as unstable and usually fixed surgically.¹⁴

Volar Barton fracture

The mirror image. The palm-side rim shears off and the wrist bones slide forward with it. Both Barton patterns are named for John Rhea Barton, whose 1838 description named the pattern², and both are usually held with a plate placed against the broken rim to buttress it.¹⁴ The volar form is the more common of the two, and even so it accounts for only about one in a hundred distal radius fractures.¹⁴

Other words on your report

A radiology report is written for the surgeon, not for you. These are the terms that most often send people searching.

• Displaced means the broken pieces have moved out of line with each other. Nondisplaced or undisplaced means they are still lined up.
• Comminuted means the bone broke into more than two pieces.
• Angulation, usually with a number of degrees, describes how far the end has tipped and in which direction.
• Intra-articular means the fracture line reached the cartilage surface of the joint. Extra-articular means it did not.
• Radial shortening means the broken end settled and the bone now sits slightly shorter than it was.
• Ulnar styloid fracture refers to the small bony bump on the pinky side. It very commonly breaks alongside the radius.¹² On its own it often needs no separate treatment. What decides whether it matters is usually the stability of the joint between the two forearm bones, not the broken tip itself.⁹
• Chauffeur fracture, also called a Hutchinson fracture, is a break of the radial styloid, the bony point on the thumb side. It runs into the joint surface, and because strong ligaments anchor at that point surgeons also assess the scapholunate ligament, which is injured alongside it in a majority of these fractures.^8,16 The name is a leftover from hand-cranked car engines kicking back.¹⁷
• Die-punch fracture describes a piece of the joint surface driven downward into the bone, most often the part the lunate sits on. It is caused by the lunate being driven down into the radius under load, and because the depression it leaves in the joint surface is hard to correct without surgery it gets close attention.¹⁰ The pattern was first described in 1962.^10,18
• AO/OTA classification is a surgeon's grading system that appears as a code such as 2R3C2, or 23-C2 in older reports.²³ The letter is the useful part: A means the joint surface is not involved, B means part of it is, and C means the joint surface has separated from the shaft entirely.
• Percutaneous pinning means wires passed through the skin to hold the pieces, usually removed later in clinic. An external fixator holds the bone from a frame outside the arm.
• Closed reduction means the pieces were pushed back into position without opening the skin. Open reduction and internal fixation, shortened to ORIF, means surgery to position the pieces and hold them, often with a plate and screws on the palm side.

Does the name decide the treatment?

Not on its own. The name describes a shape. What actually drives the decision is how far the pieces moved, whether the joint surface is involved and by how much, whether the fracture will hold its position once it is set, the quality of the bone, your age, and what your hand needs to do afterward. A carpenter and a retired librarian with identical X-rays can reasonably be offered different plans.

Broadly, undisplaced fractures that will stay put are often managed in a cast or splint. Fractures that have moved may be pushed back into place and then held. Fractures that will not hold, or that leave a step in the joint surface, are the ones most likely to be offered surgery.^6,22 Which of those describes you is a conversation with your surgeon, and it is a fair thing to ask directly.

Age changes the calculation more than most people expect. For patients over sixty-five, the current surgical guideline found that operating does not improve long-term outcomes reported by patients compared with treatment in a cast, even for fractures that have moved.^6,22 That does not mean surgery is wrong at that age. It means a cast is often a genuinely equal choice rather than a lesser one, and it is worth hearing your surgeon explain which applies to you.

What usually comes next

Whatever the pattern, a wrist that has been held still while bone heals comes out stiff. Swelling and a weak grip are ordinary at that point, and they surprise people who assumed the cast coming off was the finish line. It is closer to the halfway mark.

Keeping the fingers moving from the start is standard advice, precisely so that the stiffness is confined to the part that had to be still.²¹ After immobilization, hand therapy usually focuses on getting motion back before strength, and current rehabilitation guidance puts a home exercise program taught by a clinician at the center of that.⁷ Follow the instructions from your own team over anything you read here, including this page.

Recovery is measured in months rather than weeks: most people can use the wrist for everyday tasks by about three months, and full recovery can take up to a year.²¹ That is not a sign something has gone wrong.

One complication deserves its name. A small number of people develop complex regional pain syndrome, in which pain, swelling and changes in skin color or temperature run far beyond what the injury explains. The rehabilitation guideline lists high pain early on and low mood among the predictors, and it is one of the things your team is watching for at every visit, so pain that feels out of proportion is worth saying out loud rather than enduring.⁷

If you are over fifty

This fracture carries a message that often goes undelivered. In older adults a broken wrist from a simple fall is often the first sign of bone that has lost density.^5,15 Testing and treatment travel together: in one large study of women over fifty, those who went on to be treated were about five times as likely to have had a bone density scan, and treatment lowered the odds of breaking the wrist again by a quarter.¹⁵ Yet most people who break a wrist are never scanned at all.¹⁵

So if you are past fifty and this fracture came from standing height or less, ask your doctor whether a bone density scan is warranted.²¹ It is a short question, and it may be the most useful one on this page.

When to be seen urgently

Most of a fracture recovery is uneventful. These are the signs that should not wait for the next scheduled appointment.

• Numbness or pins and needles that is getting worse, especially across the thumb, index, middle and half the ring finger. Pressure on the nerve inside the carpal tunnel complicates roughly one in twenty of these fractures, usually within the first week, and worsening numbness is a reason to be seen the same day.^11,19
• Pain that is escalating rather than settling, particularly if straightening the fingers makes it much worse.²⁰
• Fingers that turn pale, blue or cold, or swelling that keeps increasing
• A cast or splint that feels dangerously tight, or burning and rubbing underneath it
• Fever, spreading redness, or fluid coming from a surgical wound

If you cannot reach your surgeon or therapist quickly and any of the above is happening, urgent care or an emergency department is the right call. Pressure problems and nerve problems after a wrist fracture are treatable, and they are treated best early.

Common questions