![]() ![]() The same close follow-up with serial examinations, repeat radiographs, and regular cast changes as outlined earlier in the treatment of reduced Colles’ fractures should be used in the management of Smith's fractures.ĭiego L. ![]() Severe comminution, intraarticular extension, and inability to maintain the reduction by closed means are indications for orthopedic referral. Postreduction radiographs are taken, and the same criteria for acceptable reduction as with the Colles’ fracture are used. The patient is placed in a single or double sugar-tong splint with the elbow flexed to 90 degrees, the forearm in neutral pronation–supination, and the wrist in slight extension. The thumbs are placed on the volar aspect of the wrist and are used to push the distal fragment dorsally. While maintaining traction, the fingers of both hands support the proximal forearm fragment. The anesthesia and distraction techniques (finger traps or countertraction) are the same as described for a Colles’ fracture. Most Smith's fractures should be referred to an orthopedic surgeon, but a primary care provider skilled in fracture reduction techniques may attempt closed reduction if the fracture is extraarticular (Frykman type I or II). The fracture may be extraarticular or intraarticular or may be part of a fracture dislocation of the wrist. Radiographs show a fracture of the distal radius, usually cortex to cortex through the metaphysis, with volar displacement of the distal radial fragment ( Fig. Extension of the wrist accentuates the deformity. During examination, the patient demonstrates fullness at the volar aspect of the wrist caused by volar displacement of the distal fracture fragment and has a dorsal prominence at the distal end of the proximal fragment. Less commonly, cyclists may sustain this fracture if they are thrown over the handlebars. The cause of injury is usually a direct blow to the dorsum of the wrist. Smith's fracture of the distal radius, sometimes referred to as the reverse Colles’ fracture, is an uncommon and usually unstable fracture in which the distal radial fragment is displaced volarly and proximally (the so-called garden spade deformity). Co-Author Adam Prawer, in Fracture Management for Primary Care (Third Edition), 2012 Smith's Fracture ![]()
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