Smith's Fracture

What is Smith's Fracture?

Smith's Fracture, also known as a reverse Colles' fracture or Goyrand-Smith's fracture, is a fracture involving the distal forearm. The condition has been named after Robert William Smith (1807-1873) who worked as a surgeon in Dublin, Ireland.

The difference between Colles’ fracture and Smith’s fracture is that the former is caused by a direct blow onto extended wrists, while in the latter it occurs due to a direct blow on flexed wrists.

Also, in Smith’s fracture, the fractured distal fragment is displaced ventrally while in the case of Colles’ fracture, the fragments are displaced dorsally. Depending on the severity of the fracture there may be more than one fragments and it may or may not include the wrist joint’s articular surface.

Smith's fractures are not as common as Colles' fractures. They account for less than 3% of all fractures involving the radius and the ulna. They are most commonly seen to occur in young males and elderly females.

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Causes of Smith’s Fracture

There are two ways by which Smith’s fractures usually occur:

• A fall onto a flexed wrist

• A direct blow to the back of the wrist

Types of Smith’s Fracture

There are three types of Smith’s fractures:

• Type I
• This type is an extra-articular transverse fracture that occurs through the distal radius
• It is the most common type accounting for ~85% of Smith’s fracture
• Type II
• This is an intra-articular oblique type of fracture
• It accounts for ~13% of Smith’s fractures
• Type III
• This is a juxta-articular oblique type of fracture
• It is rather uncommon and accounts for less than <2%

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Treatment for Smith’s Fracture

Treatment depends on the type of fracture. It also depends on the stability and the ability of the fracture to reduce successfully. The majority of Smith’s fractures are treated through closed reduction, by immobilizing the fractured wrist with the help of a cast.

If it cannot be treated through closed reduction, a surgery may have to be carried out.

Prognosis of Smith’s Fracture

If the fracture has not joined or healed well, then a cosmetic deformity, known as the ‘garden spade’ deformity, could result. This deformity can also result in the carpel tunnel syndrome, which is an arm and hand condition that causes numbness, tingling and pain.