A Smith's fracture, is a fracture of the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

radius In classical geometry, a radius ( : radii) of a circle or sphere is any of the line segments from its center to its perimeter, and in more modern usage, it is also their length. The name comes from the latin ''radius'', meaning ray but also the ...

. Although it can also be caused by a direct blow to the dorsal forearm or by a fall with the wrist flexed, the most common mechanism of injury for Smith's fracture occurs in a palmar fall with the wrist joint slightly dorsiflexed. Smith's fractures are less common than Colles' fractures. The distal fracture fragment is displaced volarly (

ventrally Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

), 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 In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carpal ...

Classification

A commonly used classification of distal radial fractures is the Frykman Classification: * Type I: Extra-articular * Type II: Type I, with fracture of distal ulna * Type III: Radiocarpal joint involvement * Type IV: Type III with fracture of distal ulna * Type V: Distal radioulnar joint involved. * Type VI: Type V with fracture of distal ulna * Type VII: Radiocarpal and distal radioulnar joint both involved. * Type VIII: Type VII with fracture of distal ulna.

Presentation

Complications

The biggest concern is malunion of the wrist due to poor reduction or shortening of the distal radius. This can result in a permanent "garden-spade deformity". There are also higher risks of carpal tunnel syndrome and osteoarthritis in patients with a previous Smith fractures. Entrapment of the extensor pollicis longus can also occur in cases of non-union, and can result in late rupture of this tendon. Complex regional pain syndrome can be reported in up to 40% of fractures.

Diagnosis

Physical examination

Classic physical examination findings of a Smith's fracture is palmar displacement of the wrist that results in a "garden-spade deformity".

Investigation

Two views should be obtained: AP and lateral. PA radiography will look very similar to a Colles' fracture, with a fracture along the distal metaphysis of the radius (can be shortened or comminuted). Lateral radiography will demonstrate volar angulation / displacement of the fracture.

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 Reduction is a surgical procedure to repair a Fracture (bone), fracture or Dislocation (medicine), dislocation to the correct alignment. Description When a bone fractures, the fragments lose their alignment in the form of Displacement (Orthopedic ...

(putting into place without surgery). Significant angulation and deformity may require an open reduction and internal fixation. An open fracture will always require surgical intervention. Indications for operative management include dorsal or volar comminution, intra-articular involvement, instability post-reduction, angulation greater than 20 degrees, surface step-off over 2mm or shortening of the radius greater than 5mm. For a closed reduction, the approach is the opposite of reductions completed for Colle's fractures. In the case of a Smith's fracture, the wrist must be reduced and splinted in extension.

Eponym

This fracture is named after the

orthopedic surgeon Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

, Robert William Smith (1807–1873) in his book ''A Treatise on Fractures in the Vicinity of Joints, and on certain forms of Accidents and Congenital Dislocations'' published in 1847.

References

External links

Radiograph of Smith's fracture
{{DEFAULTSORT:Smith's Fracture Bone fractures