Smith Fracture – Causes, Symptoms and Treatment
A Smith fracture is a break of the distal radius (forearm bone) in which the bone fragment tilts toward the palm. It is considered the reverse of a Colles fracture.
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A Smith fracture is a break of the distal radius (forearm bone) in which the bone fragment tilts toward the palm. It is considered the reverse of a Colles fracture.
What Is a Smith Fracture?
A Smith fracture is a fracture of the distal radius -- the lower end of the radius bone near the wrist. The broken fragment tilts toward the palmar side (inner surface of the hand), which is why it is also known as a reverse Colles fracture. The condition was first described by Irish surgeon Robert William Smith in the 19th century and remains one of the most common wrist fractures seen in emergency medicine.
Causes and Mechanism
Smith fractures typically result from a fall or direct impact on the wrist. Common mechanisms include:
- Falling onto the back of a flexed (bent) hand
- Direct blow to the back of the wrist
- Road traffic accidents or sports injuries
The fracture is more common in younger, active individuals as well as older people with osteoporosis, a condition that reduces bone density and increases fracture risk.
Classification (Thomas Classification)
Smith fractures are classified into three types according to the Thomas classification:
- Type I: Extra-articular fracture (does not involve the joint surface)
- Type II: Intra-articular fracture (involves the joint surface)
- Type III: Intra-articular fracture with a palmarly displaced joint fragment (also referred to as a Barton fracture)
Symptoms
Common symptoms of a Smith fracture include:
- Severe pain in the wrist area
- Swelling and bruising around the wrist
- Visible deformity with the hand displaced toward the palm (garden spade deformity)
- Restricted range of motion in the wrist
- Numbness or tingling in the fingers (if nerves are involved)
Diagnosis
Diagnosis is established through:
- Clinical examination: Assessment of pain, swelling, and deformity
- X-ray: Standard anteroposterior and lateral views confirm palmar angulation of the distal fragment
- CT scan (Computed Tomography): Used for complex or intra-articular fractures to evaluate joint surface involvement in detail
Treatment
Conservative Treatment
Stable, non-displaced fractures may be managed conservatively with a below-elbow plaster cast for approximately 4 to 6 weeks. Regular X-ray check-ups are essential to detect any secondary displacement of the fragment.
Surgical Treatment
Displaced, unstable, or intra-articular fractures usually require surgical fixation. Common techniques include:
- Volar plate fixation: Stabilization using an angle-stable plate and screws applied to the palmar side of the radius
- Kirschner wire fixation: Used for simpler fracture patterns
- External fixator: Indicated for highly comminuted fractures or significant soft tissue injury
Rehabilitation
Following immobilization or surgery, structured physiotherapy is essential to restore wrist mobility, strength, and function. Full recovery may take several months depending on fracture severity and the age of the patient.
Complications
Potential complications associated with a Smith fracture include:
- Carpal tunnel syndrome due to compression of the median nerve
- Chronic wrist pain
- Reduced range of motion and functional impairment
- Post-traumatic wrist osteoarthritis
- Malunion if the fracture is not adequately stabilized
References
- Wolfe S.W. et al. (eds.): Green's Operative Hand Surgery, 7th edition, Elsevier, 2017.
- Egol K.A., Koval K.J., Zuckerman J.D.: Handbook of Fractures, 5th edition, Wolters Kluwer, 2014.
- Netter F.H.: Atlas of Human Anatomy, 7th edition, Elsevier, 2018.
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