Smith fracture


Smith fracture

Description, Causes and Risk Factors:

A Smith's fracture, also sometimes known as a reverse Colles' fracture is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension. Smith's fractures are less common than Colles' fractures.

The distal fracture fragment is displaced volarly (ventrally), as opposed to a Colles' fracture which the fragment is displaced dorsally. Depending on the severity of the impact, there may be one or many fragments and it may or may not involve the articular surface of the wrist joint.

The fracture can be split into three types

type I:

  • extra-articular transverse fracture through the distal radius.

  • most common: ~ 85%.

type II:

  • intra-articular oblique fracture.

  • equivalent to a reverse Barton fracture.

  • ~13%.

type III:

  • juxta-articular oblique fracture.

  • uncommon: <2%.

Smith fractures account for less than 3% of all fractures of the radius and ulna and have a bimodal distribution: young males (most common) and elderly females.

Symptoms:

Common symptoms of a Smith's fracture are:

    Pain.

  • Swelling.

  • Deformity in the front of your forearm near the wrist.

  • Loss of motion in the hand and wrist.

  • Bruising in the hand or wrist.

Diagnosis:

In most instances plain films suffice for diagnosis and characterization. The fracture line is usually evident, although in undisplaced of mildly impacted fractures it can be difficult to see and subtle cortical breaches / buckling should be sought. In intra-articular fractures (type II) the degree of articular step-off and gap should be assessed, and this may require CT.

Treatment:

Treatment of this fracture depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation. An open fracture will always require surgical intervention.

In all types of Smith's fracture reduction can usually be effected by a manipulation like that used for a Colles's fracture, but with all movements reversed. Maintenance of reduction is extremely uncertain, however, and redisplacement of the fracture almost invariably occurs, resulting in an ugly wrist with impaired function. Most orthopaedic surgeons seem to be aware of the poor results of treatment of this fracture, but none of the descriptions of treatment in the standard text-books of surgery stresses the difficulty of maintaining reduction by ordinary methods of splintage. If it can be assumed that the Smith's fracture is caused by a pronation force, full supination of the hand would be expected to aid reduction. Maintenance of the fully supinated position should also prevent relapse of the fracture into a position of deformity.

Physical therapy for a Smith's fracture will focus on decreasing pain and swelling and improving hand, wrist and elbow range of motion and strength. Improving arm use and function is also an important component of your physical therapy program after a Smith's fracture.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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