SMITH’s FRACTURE

INTRODUCTION:

                            Smith’s Fractures is also known as a Goyrand Fracture in French literature. Smith’s fracture is palmarly displaced distal radius fracture. It is referred to as “GARDEN SPADE” deformity. Smith’s fracture is a reversed Colle's fracture.     

ANATOMY:

EPIDEMIOLOGY:

                           Smith’s fracture account for less than 3% of all fractures of the radius and ulna and have a bi-modal distribution: young males (most common) and elderly females.

MECHANISM:

Smith’s fractures usually occur in one of the 2 ways:

Ø  a fall onto a flexed wrist

Ø  direct blow to the back of the wrist

SIGNS AND SYMPTOMS:

Ø  Typically acute pain in the wrist from an impact or a fall.

Ø  Tenderness in the affected area.

Ø  Pain is felt while moving the wrist.

Ø  Development of swelling.

Ø  Wrist may become deformed.

Ø  Appearance of hand being downwards.

Ø   Fractured site may develop a cracking noise.

Ø  Symptoms of fever few hours after injury.

CLASSIFICATION:

                SMITH’S FRACTURE can be broadly be classified into two types.

·         NONDISPLACED FRACTURE: This is frequently called as mild fracture. The treatment for this condition is casting. Once the problem is diagnosed immediate attention must be given. The area of the fracture gets healed in few weeks.

·         DISPLACED FRACTURE: This type of fracture is very severe in nature. Displaced generally leads to very serious and dangerous damage to the bone. In this condition the joint of the wrist is often displaced forward creating discomfort over the wrist while moving in some angles.

                 Types of SMITH’S FRACTURE classified based on the type of injury.

                                         

INVESTIGATION:

Ø  X-ray of the wrist.

Ø  CT is advisable in Comminuted type of fracture

Ø  MRI in rare cases.

TREATMENT:

                  Smith’s Fractures can be treated with manipulation and reduction.

v  NONSURGICAL TREATMENT: Conservatives measures involve closed reduction with use of local anesthesia and then casting of hand to thumb. It takes about 10 weeks for complete recovery, which involves period of immobilization(casting/slab) for about a month and then splinting for 6 weeks. 

v  SURGICAL TREATMENT: Surgery is needed in majority of cases with Smiths Fracture as the deformity cannot be treated with nonsurgical means. This method is termed as OPEN REDUCTION INTERNAL FIXATION(ORIF).

This is done by creating an incision for interpretation of fracture and to get it back to its normal place. This at times requires pins, screws, etc for fixation.

PHYSIOTHERAPY:

This is essential for everyone for appropriate healing and normalizes function of wrist and hand can include:

·         Joint mobilization.

·         Soft tissue massages.

·         Ice and heat.

·         Therapy focusing on improving the strength.

·         Activity modifications.

·         Attempts at returning to activity.

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