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Health condition · Clinically reviewed

Broken wrist, from Colles and scaphoid fractures to modern fixation and recovery.

One of the commonest fractures at any age. Get the pattern right, protect the median nerve, and rehabilitate hard, and most wrists come back to full function.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA and BSSH standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including volar locking plates, MRI for occult scaphoid injury and fragility fracture pathways.

Key facts

A broken wrist at a glance.

The essentials, in plain English. What it is, the common patterns, and how it is treated in the UK today.

  • What it is

    A break in one of the bones that make up the wrist, most often the distal radius but sometimes a carpal bone such as the scaphoid.

  • Two peaks

    Young adults after high-energy sport, falls or road traffic collisions; older adults after a simple fall on an outstretched hand.

  • Colles fracture

    The classic dorsally displaced distal radius fracture with a dinner-fork deformity, typical after a fall on an outstretched hand.

  • Scaphoid fracture

    The commonest carpal fracture, easy to miss on early X-rays and at real risk of avascular necrosis of the proximal pole.

  • Fragility fracture

    A wrist break from a low-energy fall over the age of fifty is a fragility fracture and a gateway to bone-health assessment.

  • Modern fixation

    Volar locking plates, K-wires and Herbert screws allow early mobilisation and better long-term function than plaster alone.

Why this guide matters

The right pattern, the right plan.

Broken wrists look similar from the outside, but the pattern underneath dictates almost everything about the treatment.

  • Pattern matters more than pain

    Colles, Smith, Barton, chauffeur, Galeazzi, scaphoid and perilunate injuries all need different plans. Getting the pattern right is step one.

  • Protect the median nerve

    Progressive numbness after a distal radius fracture is treated as an emergency. Acute carpal tunnel syndrome after a wrist fracture is time-critical.

  • Fragility fractures are a warning

    A wrist fracture from a low-energy fall over fifty is your fracture liaison moment. Bone-health assessment prevents the next, more serious break.

How the diagnosis is made

From the fall to a clear fracture plan.

What a UK emergency doctor, orthopaedic team or hand surgeon will do, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and mechanism

    Simple trip versus high-energy fall, sport injury or road traffic collision. Mechanism steers the search for occult and intra-articular injury.

  2. 02

    Assessing

    Examination and Ottawa rules

    Look for deformity, swelling, snuff-box tenderness and axial load pain. Ottawa wrist rules help decide who needs imaging.

  3. 03

    Assessing

    Neurovascular check

    Median nerve most at risk in the carpal tunnel. Sudden or progressive numbness after a distal radius fracture is treated as acute carpal tunnel syndrome.

  4. 04

    Confirming

    Plain X-ray series

    AP, lateral and oblique views of the wrist, with dedicated scaphoid views when a carpal injury is suspected.

  5. 05

    Confirming

    CT for complex fractures

    Used for comminuted or intra-articular distal radius fractures, preoperative planning and confirming scaphoid non-union.

  6. 06

    Preparing

    MRI for occult injury

    The gold standard for suspected scaphoid fracture with normal X-rays, bone bruising, ligament injury and early avascular necrosis.

  7. 07

    Preparing

    Bone health and follow-up

    DEXA and fracture liaison service review for fragility fractures, plus tetanus cover and Gustilo-Anderson grading for any open injury.

Typical timeline: A&E to a definitive plan usually within days, sooner if surgery is needed.

Symptoms

What a broken wrist actually looks like.

The obvious features, plus the subtler clues to scaphoid injury and median nerve pressure that change the plan.

  • Pain and swelling

    Immediate wrist pain, rapid swelling and bruising after the injury, worse with any attempt to move the hand.

  • Dinner-fork deformity

    The classic dorsal step in a Colles fracture, visible from the side of the forearm just above the wrist crease.

  • Reduced range of movement

    Loss of wrist extension, flexion and rotation, with pain on gripping or turning a doorknob.

  • Snuff-box tenderness

    Point tenderness in the anatomical snuff-box after a fall on an outstretched hand suggests a scaphoid fracture until proven otherwise.

  • Weak or painful grip

    Loss of grip strength and pain on pinch or twist, a common early clue to scaphoid and carpal injury.

  • Numbness or tingling

    Pins and needles in the thumb, index and middle fingers point to median nerve pressure and may need urgent decompression.

  • Bruising and blistering

    Extensive bruising, fracture blisters and skin tenting can influence timing and choice of fixation.

  • Red flag, open or deformed wrist

    Any open wound, gross deformity, cold or pale hand needs emergency care, not a wait-and-see approach.

Treatment

How a broken wrist is treated in the UK.

Cast, K-wires, volar locking plate or Herbert screw, with hand therapy at the heart of every plan.

  • Moulded plaster cast

    For undisplaced or minimally displaced distal radius fractures, typically four to six weeks with clinic review and repeat X-rays.

  • Manipulation and K-wires

    Closed reduction under anaesthetic with percutaneous K-wires for displaced but reducible distal radius fractures.

  • Volar locking plate (ORIF)

    Open reduction and internal fixation via a volar Henry approach, the workhorse for displaced or intra-articular distal radius fractures.

  • External fixator

    Used for highly comminuted or open distal radius fractures, sometimes combined with limited internal fixation.

  • Scaphoid cast

    A thumb spica cast for six to twelve weeks in undisplaced scaphoid fractures, with repeat imaging to confirm union.

  • Herbert screw fixation

    Percutaneous or open compression screw for displaced, proximal pole or non-union scaphoid fractures, sometimes with vascularised bone graft.

  • Perilunate reduction and repair

    Urgent closed reduction then open ligament repair and K-wire stabilisation by a specialist hand surgeon.

  • Hand therapy and rehabilitation

    Structured occupational and physiotherapy after cast or surgery, restoring range, grip and confidence over three to six months.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your emergency department, orthopaedic surgeon or hand therapist knows the imaging and can tell you which parts apply to your wrist. If in doubt, get seen.

  • NICE. Fractures (non-complex): assessment and management (NG38).

  • British Orthopaedic Association (BOA) and BSSH. BOAST: The management of distal radius fractures.

  • British Society for Surgery of the Hand (BSSH). Scaphoid fracture and non-union guidance.

  • Royal Osteoporosis Society. Fracture Liaison Service standards for fragility fractures.

Red flags

When a broken wrist needs urgent attention.

Most wrist fractures are managed in the fracture clinic. These are the situations that cannot wait.

  • Acute carpal tunnel syndrome

    Progressive median nerve numbness, severe pain or weakness after a distal radius fracture needs urgent decompression, treated as a compartment-syndrome equivalent.

  • Open fracture

    Any break in the skin over a suspected fracture is an open injury. It needs antibiotics, tetanus cover and washout in theatre, ideally within 24 hours.

  • Cold, pale or pulseless hand

    Suggests vascular injury or severe swelling. This is an emergency and needs immediate assessment in A&E.

  • Perilunate or lunate dislocation

    A high-energy wrist injury with severe pain and deformity, often missed on the first X-ray. Needs urgent specialist reduction.

  • Suspected scaphoid fracture

    Snuff-box tenderness after a fall on an outstretched hand, even with a normal X-ray, needs immobilisation and repeat imaging or MRI.

  • Rapidly worsening pain in a cast

    Severe, worsening pain out of proportion to the injury, or numb fingers, should trigger urgent review to exclude compartment syndrome or cast complications.

  • Delayed extensor pollicis longus rupture

    Sudden loss of the ability to lift the thumb weeks after a Colles fracture. Needs hand surgery review for tendon transfer.

  • Complex regional pain syndrome (CRPS)

    Disproportionate pain, swelling, colour change and stiffness weeks after injury. Early recognition, physiotherapy and pain input change outcomes.

  • Fragility fracture

    A wrist fracture from a low-energy fall over fifty is a fragility fracture. Bone-health assessment and fracture liaison follow-up are essential.

Living with it

A treatable injury, with a clear recovery.

Four habits that make the biggest difference. Move what you can from day one, look after the cast, commit to hand therapy, and take a fragility fracture as the warning it is.

A quiet reminder

Rehab is the treatment, not the afterthought.

A perfect X-ray does not equal a functioning wrist. The people who do best are the ones who put the hours into hand therapy.

  1. 01 Early

    Move what you can

    Keep the fingers, elbow and shoulder moving from day one. Elevation and gentle finger exercises cut swelling and stiffness.

  2. 02 Cast

    Look after the cast

    Keep it dry, watch for numbness, tight swelling or new pain, and go back to clinic early rather than late if anything worries you.

  3. 03 Recovery

    Hand therapy really helps

    A structured programme with a hand therapist restores range, grip and confidence far faster than working it out at home.

  4. 04 Bone

    Take fragility fractures seriously

    If a simple fall broke your wrist after fifty, ask about DEXA and bone-protection treatment. The next fracture is preventable.

Frequently asked

Everything we get asked about a broken wrist.

Quick answers on fracture types, scaphoid injury, surgery and recovery.

  • What is a broken wrist?

    A broken wrist means a fracture of one of the bones around the wrist joint. Most commonly this is the distal radius, at the end of the forearm bone, but it can also involve the ulna or one of the eight carpal bones, most often the scaphoid.

  • What is the difference between a Colles and a Smith fracture?

    Both are distal radius fractures. A Colles fracture is dorsally displaced, typically after a fall on an outstretched hand, and gives the classic dinner-fork deformity. A Smith fracture is the reverse pattern, with volar (palm-side) displacement, usually after a fall onto the back of a flexed wrist.

  • Why is a scaphoid fracture such a concern?

    The scaphoid has a fragile blood supply that runs from its distal end backwards. A fracture, especially of the proximal pole, can cut off this supply and lead to avascular necrosis and non-union. Around one in ten scaphoid fractures do not show on the first X-ray, so a period of immobilisation with repeat imaging or MRI is standard.

  • Do I always need surgery for a broken wrist?

    No. Many distal radius fractures are undisplaced or can be reduced and held in a moulded cast. Surgery, such as K-wires, a volar locking plate or a Herbert screw, is used when the fracture is displaced, intra-articular, unstable, involves the scaphoid proximal pole, or when early return to function matters, particularly in younger, active patients.

  • How long does a broken wrist take to heal?

    Most distal radius fractures unite in six to eight weeks, with functional recovery over three to six months. Scaphoid fractures often take eight to twelve weeks in a cast, longer if the proximal pole is involved. Return to contact sport is usually three to six months and depends on healing, strength and confidence.

  • What if my wrist is still painful and stiff after the cast comes off?

    Some stiffness and weakness is normal for weeks. Hand therapy is the fastest route back to function. Persistent pain, deformity, numbness or a loss of thumb movement should prompt review to exclude malunion, tendon injury, delayed carpal tunnel syndrome or complex regional pain syndrome.

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