Difference between revisions of "Smith's fracture"
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==Background== | ==Background== | ||
| − | *Volar angulated fracture ("reverse Colles fracture" or "garden-spade deformity") | + | *Also known as a reverse Colles' fracture or Goyrand-Smith's |
| − | + | *Volar angulated fracture of distal radius ("reverse Colles fracture" or "garden-spade deformity") | |
==Clinical Features== | ==Clinical Features== | ||
| + | *Mechanism: fall onto the dorsum of the hand with wrist in flexion, or direct blow to dorsum of hand/wrist<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | ||
| + | *Wrist pain | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 9: | Line 11: | ||
==Evaluation== | ==Evaluation== | ||
| − | * | + | *Assess distal pulse, motor, and sensation |
| + | *Inspect skin for any signs of open fracture | ||
| + | *XRay | ||
| + | **AP/Lateral of wrist and forearm | ||
| + | *If intraarticular, may need CT for surgical planning | ||
==Management== | ==Management== | ||
| + | {{General Fracture Management}} | ||
| + | |||
| + | ===Immobilization=== | ||
*[[Sugar tong splint]] in supination<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | *[[Sugar tong splint]] in supination<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | ||
**Similar to [[Colles' fracture]] | **Similar to [[Colles' fracture]] | ||
| + | *Typically unstable and requires surgical fixation | ||
==Disposition== | ==Disposition== | ||
| − | *Outpatient | + | *Outpatient with Ortho follow-up |
| + | |||
| + | ==Complications== | ||
| + | *Malunion can result in chronic garden spade deformity | ||
| + | **Can also lead to [[Carpal tunnel syndrome]] | ||
==See Also== | ==See Also== | ||
*[[Distal radius fractures]] | *[[Distal radius fractures]] | ||
| + | |||
| + | ==External Links== | ||
| + | *https://radiopaedia.org/articles/smith-fracture | ||
==References== | ==References== | ||
<references/> | <references/> | ||
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| − | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 04:27, 18 September 2019
Contents
Background
- Also known as a reverse Colles' fracture or Goyrand-Smith's
- Volar angulated fracture of distal radius ("reverse Colles fracture" or "garden-spade deformity")
Clinical Features
- Mechanism: fall onto the dorsum of the hand with wrist in flexion, or direct blow to dorsum of hand/wrist[1]
- Wrist pain
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
| Eponyms | Description |
| Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
| Chauffer's | Fracture of radial styloid |
| Colles' | Dorsally displaced, extra-articular fracture |
| Die-punch | Depressed fracture of the lunate fossa (articular surface) |
| Smith's | Volar displaced, extra-articular fracture |
Evaluation
- Assess distal pulse, motor, and sensation
- Inspect skin for any signs of open fracture
- XRay
- AP/Lateral of wrist and forearm
- If intraarticular, may need CT for surgical planning
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Sugar tong splint in supination[1]
- Similar to Colles' fracture
- Typically unstable and requires surgical fixation
Disposition
- Outpatient with Ortho follow-up
Complications
- Malunion can result in chronic garden spade deformity
- Can also lead to Carpal tunnel syndrome