Smiths fracture

In the US, about 17% of the emergency room visits are due to wrist injuries. Injury of the forearm bone near the wrist joint is known as Smith's fracture. Smith's fracture is a fracture of the distal radius occurring about 2.5 cm from the wrist joint. The fracture is the result from a backward fall onto the outstretched hand. It was the orthopedic surgeon Robert William Smith who described this fracture in his book 'A treatise on fractures in the vicinity of joints, and on certain forms of accidents and congenital dislocations' published in 1847. This fracture is named after him. Smith's fracture is often described as a garden-spade deformity.

Hands perform so many tasks that are fundamental and delicate. Therefore even a minor injury to the hand and wrist can have devastating consequences. Smith's fracture is unstable as the ulnar head can be displaced dorsally and therefore requires urgent attention. The hand and the wrist are so dependent on each other. Therefore when an injury occurs, it affects both the hand and wrist. Smith's fracture are classified as:

Type I: Most stable, extra articular transverse distal radial fracture with palmar and proximal displacement.

Type II: Barton type, palmar-lip fracture of the distal radius with dislocation of the carpus
Type III: Unstable, oblique juxta articular fracture of the distal radius and tilted palmar.

• A Smith's fracture is most commonly caused by people falling onto hard surface and breaking their fall with flexed wrists.
  
• Smith's fracture most commonly occurs in older post- menopausal women exhibiting osteoporosis.
  
• Smith's fracture occurs in adolescent boys and girls with joint surface displacement.
  
• Smith's fracture can be considered as a sports injury
  
  Common complications from Smith's fracture:
• Ulnar nerve injury
  
• Carpal tunnel syndrome
  
• Post traumatic radio carpal osteoarthritis with limited range of motion
  
• Heterotopic ossification
  
• Reflex sympathetic dystrophy
  
• Tendon rupture
  
• Nonunion
  
• Radial shortening

Treatment for Smith's fracture depends much upon the severity of the fracture and other factors such as connective tissue injuries, musculoskeletal structure and neuroanatomy, and dislocations involved. If the fracture is not a displaced fracture, then it can be treated simply with a 'cast' alone. Nevertheless, casting needs close watch so as to ensure that the fracture stays in proper position.