Smith's fracture

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Smith's fracture
Other namesReverse Colles' fracture, Goyrand-Smith's
Smith2019Frac.jpg
Smith's fracture
Specialty Orthopedics

A Smith's fracture, is a fracture of the distal radius. [1]

Contents

Although it can also be caused by a direct blow to the dorsal forearm [2] 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. [3] Smith's fractures are less common than Colles' fractures.

The distal fracture fragment is displaced volarly (ventrally), 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.

Classification

A commonly used classification of distal radial fractures is the Frykman classification: [4]

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.[ citation needed ]

Entrapment of the extensor pollicis longus can also occur in cases of non-union, and can result in late rupture of this tendon.[ citation needed ]

Complex regional pain syndrome can be reported in up to 40% of fractures. [5]

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. [6]

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 (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.[ citation needed ]

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. [5]

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. [5]

Eponym

This fracture is named after the orthopedic surgeon, 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. [7]

Related Research Articles

<span class="mw-page-title-main">Ulna</span> Medial bone from forearm

The ulna or ulnar bone is a long bone in the forearm stretching from the elbow to the wrist. It is on the same side of the forearm as the little finger, running parallel to the radius, the forearm's other long bone. Longer and thinner than the radius, the ulna is considered to be the smaller long bone of the lower arm. The corresponding bone in the lower leg is the fibula.

<span class="mw-page-title-main">Wrist</span> Part of the arm between the lower arm and the hand

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; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is used to describe the entire appendage of the upper limb, but which in anatomy, technically, means only the region of the upper arm, whereas the lower "arm" is called the forearm. It is homologous to the region of the leg that lies between the knee and the ankle joints, the crus.

<span class="mw-page-title-main">Metacarpal bones</span> Bones of hand

In human anatomy, the metacarpal bones or metacarpus, also known as the "palm bones", are the appendicular bones that form the intermediate part of the hand between the phalanges (fingers) and the carpal bones, which articulate with the forearm. The metacarpal bones are homologous to the metatarsal bones in the foot.

<span class="mw-page-title-main">Scaphoid bone</span> Bone of the carpus

The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist. It forms the radial border of the carpal tunnel. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. It is approximately the size and shape of a medium cashew nut.

<span class="mw-page-title-main">Radius (bone)</span> One of the two long bones of the forearm

The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is longer than the radius, but the radius is thicker. The radius is a long bone, prism-shaped and slightly curved longitudinally.

<span class="mw-page-title-main">Colles' fracture</span> Type of distal radius fracture

A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Symptoms may include pain, swelling, deformity, and bruising. Complications may include damage to the median nerve.

<span class="mw-page-title-main">Distal radius fracture</span> Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

<span class="mw-page-title-main">Galeazzi fracture</span> Medical condition

The Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radioulnar joint. It classically involves an isolated fracture of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the distal radio-ulnar joint; the injury disrupts the forearm axis joint.

<span class="mw-page-title-main">Madelung's deformity</span> Type of malformation of the wrist bones

Madelung's deformity is usually characterized by malformed wrists and wrist bones and is often associated with Léri-Weill dyschondrosteosis. It can be bilateral or just in the one wrist. It has only been recognized within the past hundred years. Named after Otto Wilhelm Madelung (1846–1926), a German surgeon, who described it in detail, it was noted by others. Guillaume Dupuytren mentioned it in 1834, Auguste Nélaton in 1847, and Joseph-François Malgaigne in 1855.

<span class="mw-page-title-main">Distal radioulnar articulation</span>

The distal radioulnar articulation is a synovial pivot joint between the two bones in the forearm; the radius and ulna. It is one of two joints between the radius and ulna, the other being the proximal radioulnar articulation. The joint features an articular disc, and is reinforced by the palmar and dorsal radioulnar ligaments.

<span class="mw-page-title-main">Palmar radiocarpal ligament</span>

The palmar radiocarpal ligament is a broad membranous band, attached above to the distal end of the radius, and passing downward to the scaphoid, lunate, triquetrum and capitate of the carpal bones in the wrist.

<span class="mw-page-title-main">Intercarpal joints</span> Joints of the carpal bones of the wrist

The intercarpal joints can be subdivided into three sets of joints : Those of the proximal row of carpal bones, those of the distal row of carpal bones, and those of the two rows with each other.

<span class="mw-page-title-main">Triangular fibrocartilage</span> Anatomical feature in the wrist

The triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

<span class="mw-page-title-main">Barton's fracture</span> Medical condition

A Barton's fracture is a type of wrist injury where there is a broken bone associated with a dislocated bone in the wrist, typically occurring after falling on top of a bent wrist. It is an intra-articular fracture of the distal radius with dislocation of the radiocarpal joint.

The Essex-Lopresti fracture is a fracture of the radial head of the forearm with concomitant dislocation of the distal radio-ulnar joint along with disruption of the thin interosseous membrane which holds them together. The injury is named after Peter Essex-Lopresti who described it in 1951.

<span class="mw-page-title-main">Wrist arthroscopy</span>

Wrist arthroscopy can be used to look inside the joint of the wrist. It is a minimally invasive technique which can be utilized for diagnostic purposes as well as for therapeutic interventions. Wrist arthroscopy has been used for diagnostic purposes since it was first introduced in 1979. However, it only became accepted as diagnostic tool around the mid-1980s. At that time, arthroscopy of the wrist was an innovative technique to determine whether a problem could be found in the wrist. A few years later, wrist arthroscopy could also be used as a therapeutic tool.

Lidström classification is a system of categorizing fractures of the distal radius, one of the two bones of the forearm. In the Lidström classification system there are six types of fractures. The classification system is based on fracture line, direction and degree of displacement, extent of articular involvement and involvement of the distal radioulnar joint, and was first published in 1959.

Nissen-Lie classification is a system of categorizing Colles' fractures. In the Nissen-Lie classification system there are seven types of fractures. The classification system was first published in 1939.

<span class="mw-page-title-main">Classification of distal radius fractures</span>

There are a number of ways to classify distal radius fractures. Classifications systems are devised to describe patterns of injury which will behave in predictable ways, to distinguish between conditions which have different outcomes or which need different treatments. Most wrist fracture systems have failed to accomplish any of these goals and there is no consensus about the most useful one.

References

  1. Thomas CL (1993). Taber's Cyclopedic Medical Dictionary (18th ed.). F.A. Davis. ISBN   0-8036-0194-8.
  2. Stead LG, Stead SM, Kaufman MS (2006). First Aid: Emergency Medicine (2nd ed.). McGraw-Hill. ISBN   0-07-144873-X.
  3. Matsuura Y, et al. (2017). "Smith's fracture generally occurs after falling on the palm of the hand". Journal of Orthopaedic Research. 35 (11): 2435–2441. doi: 10.1002/jor.23556 . PMID   28262985. S2CID   23989625.
  4. Shehovych A, Salar O, Meyer C, Ford DJ (November 2016). "Adult distal radius fractures classification systems: essential clinical knowledge or abstract memory testing?". Annals of the Royal College of Surgeons of England. 98 (8): 525–531. doi:10.1308/rcsann.2016.0237. PMC   5392888 . PMID   27513789.
  5. 1 2 3 Schroeder JD, Varacallo M (2019). "Smith's Fracture Review". StatPearls. StatPearls Publishing. PMID   31613494 . Retrieved 2019-11-20.
  6. Patel Y (2005-01-01). "Emergency Medicine Manual, (6th): By O. John Ma, David M. Cline, Judith E. Tintinalli, Gabor D. Kelen, and J Stephan Stapczynski. New York: McGraw-Hill Medical Publishing Division, 2004, 977 pages, $45.00 (softcover)". Academic Emergency Medicine. 12 (1): 95–96. doi:10.1197/j.aem.2004.07.019.
  7. synd/2150 at Who Named It?