MANUAL MINORS
Smith’s fracture is a fracture of the distal radius, similar to a Colles’ fracture but with volar (towards the palm) displacement of the distal fragment of the radius. This injury typically occurs from falling onto a flexed hand and is more common in young adults or individuals who suffer high-impact falls. Due to the direction of displacement, it is often referred to as a “reverse Colles’ fracture.”
Diagnosis
The diagnosis is based on:
Severe wrist pain, associated with swelling and, in some cases, deformity on the volar (palmar) side of the wrist.
Limitation of wrist and hand movements.
X-rays showing the displacement of the distal radius fragment towards the palm. Radiographic evaluation is crucial to determine the extent of the fracture and plan treatment.
Differential Diagnosis
Condition | Key Differences |
Colles’ Fracture | Dorsal displacement of the distal radius fragment (towards the back of the hand), not towards the palm. |
Wrist Sprain | Pain and swelling without evidence of a fracture on radiographic studies. |
Barton’s Fracture-Dislocation | Involves displacement of the distal articular fragment of the radius, with radiocarpal joint involvement. |
Scaphoid Fracture | Localised pain in the anatomical snuffbox, without visible displacement of the distal radius. |
Emergency Management
Immediate immobilisation with a splint or cast that includes the wrist and forearm, preventing movements that could worsen the displacement.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatories for pain control.
X-rays to confirm the diagnosis and assess the extent of the displacement.
In cases of significant displacement, closed reduction under local anaesthesia or sedation may be required to realign the bone fragments.
Definitive Treatment
Non-displaced or minimally displaced fractures: Managed with immobilisation in a cast for 4-6 weeks.
Displaced or unstable fractures: May require closed reduction or, in more severe cases, surgical fixation with plates and screws to ensure proper alignment and prevent long-term deformities.
After treatment, rehabilitation is essential to restore wrist mobility, strength, and function. Complications may include joint stiffness, chronic pain, or healing problems if the fracture is not treated properly.
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