Smith's fracture
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