![]() ![]() American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand clinical practice guideline summary management of distal radius fractures. Some people may benefit from surgery to improve alignment and. Doctors can treat most Colles’ fractures with casting or splinting. The fall sends force through the bones and displaces the distal radius toward the back of the hand or forearm. Distal radius fractures in the elderly population. Colles’ fractures most often occur with a fall onto an outstretched hand. Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis. Fracture of the distal radius: epidemiology and premanagement radiographic characterization. Porrino JA, Maloney E, Scherer K, Mulcahy H, Ha AS, Allan C. Smith’s fracture generally occurs after falling on the palm of the hand. J Bone and Joint Surgery.Matsuura Y, Rokkaku T, Kuniyoshi K, et al. A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms of Accidental and Congenital Dislocations, pp. The reduction is acceptable until referral for internal fixation can occur. The patient underwent reduction of the fracture, under sedation and was placed in an above elbow cast, with the wrist extended. In many instances, radiologists may accurately describe the fracture findings but may not recall the associated name given to the fracture and the mechanism of injury. The fracture may also result in acute median nerve injury (refer to examination of the hand), or delayed carpal tunnel syndrome secondary to narrowing of the entry into the canal. 1 Key Words:Wrist fractures, Barton, Reverse Barton, Colles, Smith, Chauffeur, Hutchinson Wrist fractures are a common finding. Due to the instability of the fracture, most will require internal fixation. Mal-union can result in significant deformity sometimes called a ‘garden spade deformity’. This is a difficult fracture to reduce and one that is prone to slippage of fracture fragments. A followup X-ray needs to be performed several days after the plaster is applied to assess for slippage. Supination can aid in reduction and plastering in the fully supinated position with the elbow flexed at 90 degrees can aid in keeping the fracture fragments from slipping. Attemps at initial reduction can be achieved by the opposite positioning to that of a colles fracture. In most cases Smith’s Fractures are unstable and will need internal fixation. Type III: Fractures may also be juxta-articular, entering the radoiocarpal joint.Ī Smith’s Fracture is considered the opposite of a Colles fracture. ![]() These type of fractures are also referred to as reverse Barton fractures. These usually cross into the dorsal articular surface. The side view of a wrist after a Colles fracture is sometimes compared to the shape of a fork facing down. A Colles fracture may result from direct impact to the palm, like if you use your hands to break up a fall and land on the palms. Type II: Fractures may also be intra-articular. Depending on the angle of the distal radius as it breaks, the fracture is called a Colles or Smith fracture.Thomas(2) first described this fracture type as also being associated with a fracture of the ulnar styloid(as seen here). Type I: The most common type(85%) of Smith’s fracture is the extra-articular transverse fracture through the distal radius, as in this case.It usually results from a fall onto a flexed wrist or from a direct blow to the dorsal forearm. History-taking should focus on the mechanism of injury and amount of energy involved. The diagnosis is a Smith’s Fracture of the left forearm named after Smith, who first described this in 1847(1)Ī Smith’s Fracture, sometimes also known as a Goyrand Fracture is a distal radial fracture with volar angulation of the distal fracture fragments. The deformity that results from the Colles’ fracture is described as a dinner fork' deformity because of depression at the fracture site, dorsal angulation, and dorsal displacement of the distal radius. ![]() There is also a small avulsion fracture of the ulnar styloid process and a buckle fracture of the distal ulna. The fracture does not appear to extend into the articular surface. ![]() There is a displaced fracture of the distal radial metaphysis with volar angulation of the distal fracture fragment. There was specific exclusion of any acute Median nerve deficits. On examination, the wrist appeared deformed in a classic ‘garden spade shape’, however the patient was comfortable and the limb was neurovascularly intact. There were no other injuries, however there was a history of a right sided wrist fracture in the recent past. The patient had fallen onto his flexed left wrist during a football match. ![]()
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