Smith Fracture

Medically reviewed by William Morrison, MD on November 14, 2017Written by Mariah Adcox on November 14, 2017

What is a smith fracture?

A smith fracture is a fracture of the distal radius. The radius is the larger of the two bones in the arm. The end of the radius bone toward the hand is called the distal end. A smith fracture is also associated with something called palmar angulation of the distal fragment. This means the fractured piece of bone is displaced towards the direction of the palm.

Typically, smith fractures are extra articular. This means that the fracture does not extend into the wrist joint. They are also usually transverse fractures, meaning the fracture happens at a right angle to the bone. A smith fracture is known by a few other names, such as a Goyrand fracture, and a reverse Colles fracture.

The radius is the most commonly broken bone in the arm. But smith fractures are actually rather rare. They account for less than three percent of all fractures of the radius. They are most often seen in either young males or elderly females.

What are the symptoms of a smith fracture?

The symptoms of a smith fracture are similar to other types of fractures. There is usually immediate pain, tenderness, bruising, and swelling. Depending on the severity of the fracture, the wrist may hang in an odd or bent way.

What commonly causes a smith fracture?

Typically, there are two ways you can develop a smith fracture. The first way is by falling onto your wrist while it’s flexed. The second way is from a direct blow to the back of the wrist.

Osteoporosis, a disorder where bones become more likely to break, can increase the likelihood of a small fall turning into a fracture. However, smith fractures still occur in healthy bones, especially in a high-force incident like a car crash or a fall off a bike.

How is a smith fracture diagnosed?

If you’ve fallen on your wrist, but the pain isn’t severe and your wrist is functioning, it’s possible to wait a day before seeing a doctor. You can use at-home treatments, such as a splint and ice, to treat the pain until you see a doctor.

However, if you’re experiencing any numbness, your fingers are pink, or your wrist is bent in the wrong angle, you’ll need to go to the emergency room.

Your doctor will most likely order a series of X-rays. These X-rays will let your doctor know if the bone is broken and if a bone fragment is displaced. The X-rays will also help your doctor determine the best treatment for your fracture.

Can other conditions develop if a smith fracture isn’t treated?

Proper treatment of a smith fracture is important to make sure that your bones heal properly and you keep full function of your wrist and hand. If you wait too long to see a doctor, the bones may not heal together correctly.

A possible complication of a smith fracture (or any other serious injury to a limb) is something called complex regional pain syndrome. This is a chronic pain condition that affects a limb after an injury. It is thought to be caused by damage to the nervous system.

It’s important that you speak with your doctor if you’re experiencing unrelenting pain and numbness after your injury.

How is a smith fracture treated?

Treatment for smith fractures involves putting the broken bones back together correctly, and making sure stay they stay in place until fully healed. Treatment may vary based on your age, the quality of the break, and your activity level.

There are both nonsurgical and surgical treatment options. Usually, your doctor will recommend non-surgical treatment if it’s possible. The process of moving broken bones back into place is called reduction. When this is done without surgery, it’s called a closed reduction.

After a closed reduction takes place, your doctor will likely place the wrist in a splint or cast. Typically, you’ll wear a splint at first to allow room for swelling. A week or a few days later, after the swelling has gone down, your doctor will probably replace your splint with a cast.

If the bone is so out of place that a closed reduction can’t take place, you’ll need surgery. An incision will be made to properly align the bones. Your doctor will use one of several options to hold the bone in the correct position while it heals. These options include a cast, metal pins, plates, and screws.

What is the outlook for a smith fracture?

Because there is such a wide range of smith fractures, the time it takes for any one injury to heal will depend on the type of break and the treatment. You may experience pain for a few days up to a couple of weeks. Ice, elevation, and pain medication usually helps.

The combination of ibuprofen and acetaminophen typically helps reduce both pain and swelling. If pain is even more severe, a prescription medication may be necessary.

If you need a cast, they are usually replaced as the swelling continues to go down. After about six weeks, your cast will be removed.

Almost everyone requires some form of rehabilitation. It’s common to have a certain amount of stiffness in the wrist. You can start physical therapy a few days to a few weeks after surgery to improve these symptoms. In the long term, full recovery usually takes about a year. You can probably expect pain and stiffness, especially with vigorous exercise, in the two years after your injury.

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