Smith's fracture

Background

• 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
• 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

• Sugar tong splint in supination
  • 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

See Also

• Distal radius fractures