A fracture requires immediate attention, especially when it occurs in a complex area like the wrist. Fractures of the distal radius, the end of the larger forearm bone near the wrist, are among the most common bone injuries treated by doctors. A Smith’s fracture is a specific, though less frequent, type of this injury distinguished by the direction in which the broken bone fragments shift.
Defining the Distal Radius Fracture
A Smith’s fracture is a break at the distal end of the radius bone. The defining characteristic of this injury is the displacement of the fractured bone fragment toward the palm side of the hand, known as volar displacement. This anterior shift sets it apart from other similar wrist breaks.
Smith’s fractures are often compared to the more common Colles’ fracture, as they involve opposite displacement patterns. A Colles’ fracture features the bone fragment shifting backward, or dorsally. Conversely, the Smith’s fracture involves forward, or volar, displacement. Due to this inverse relationship, a Smith’s fracture is often referred to as a reverse Colles’ fracture and is sometimes known as a Goyrand fracture.
Causes and Immediate Symptoms
A Smith’s fracture is typically caused by a fall onto the back of the hand while the wrist is flexed inward. This impact forces the distal radius fragment toward the palm. The same volar-directed force can also result from a direct blow to the back of the wrist.
Symptoms of the injury include sharp pain at the wrist and rapid swelling around the fracture site. The characteristic volar displacement of the bone fragment creates a visible deformity on the wrist’s palm side. This abnormal contour is sometimes described as a “garden spade” or “inverse dinner fork” deformity.
Navigating Treatment Options
The treatment approach for a Smith’s fracture is determined by the stability and severity of the break. For fractures that are non-displaced or minimally displaced and stable, treatment is typically non-surgical. This involves a closed reduction, where a doctor manually realigns the broken bone fragments without surgery while the patient is under anesthesia or sedation.
Following a successful reduction, the wrist is immobilized in a cast or splint, usually for six to eight weeks, to allow the bone to heal. Smith’s fractures are generally more unstable than Colles’ fractures, meaning there is a high risk that the bone fragments may shift out of place during the healing period. Regular X-rays are necessary to monitor the fracture alignment and ensure the reduction is maintained.
Surgical intervention is indicated for unstable fractures, those with significant displacement, or when the fracture extends into the joint surface. The most common procedure is Open Reduction and Internal Fixation (ORIF), which involves making an incision to realign the bone fragments. A metal plate and screws are then inserted, often on the palm side of the radius, to hold the fragments securely in place during healing.
Internal fixation using a plate, known as volar plating, is effective for managing the volar displacement pattern of a Smith’s fracture. In some cases, especially with comminuted or open fractures, external fixation may be used, where a frame is placed outside the body with pins anchoring the bone fragments. Surgical stabilization is often necessary to achieve and maintain the precise alignment required for optimal long-term wrist function.
Recovery and Rehabilitation
The post-treatment phase begins immediately after immobilization or surgery and focuses on restoring full wrist function. Following the period of casting or splinting, which can last from four to eight weeks, the wrist will typically be stiff and weak.
Physical therapy is a core part of recovery, often beginning with gentle range-of-motion exercises one to two weeks after surgery or casting removal. Rehabilitation focuses on increasing flexibility, regaining grip strength, and improving dexterity. Full recovery can take several months, often up to a year to fully regain pre-injury strength and mobility. Long-term complications, such as chronic stiffness, pain, or post-traumatic arthritis, may occur if the fracture involved the joint surface or did not heal in proper alignment.