Malunion, with a residual volar displacement of the distal radius results in a cosmetic deformity, referred to as a garden spade deformity. If the fracture can be reduced but remains unstable, or cannot be reduced then operative fixation ( ORIF) is usually required 1. In most cases, these fractures can be treated with closed reduction and cast application 1. Treatment depends on the type of fracture, stability and ability to successfully reduce the fracture. assess articulation of radio-lunate and radio-scaphoid joint.ensure no carpal malalignment or fractures are present.History-taking should focus on the mechanism of injury and amount of energy involved. location (extra-, juxta- or intra-articular) 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.In addition to reporting the presence of a distal radial fracture with volar angulation a number of features should be sought and commented upon: In intra-articular fractures (type II) the degree of articular step-off and gap should be assessed, and this may require CT. The fracture line is usually evident, although in undisplaced or mildly impacted fractures it can be difficult to see and subtle cortical breaches/buckling should be sought.
COLLES FRACTURE VS SMITH FRACTURE X RAY SERIES
In most instances, a plain wrist radiographic series will suffice for diagnosis and characterization.
Smith fractures usually occur in one of two ways: J Bone and Joint Surgery.Smith fractures account for less than 3% of all fractures of the radius and ulna and have a bimodal distribution: young males (most common) and elderly females 1. 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. 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. 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’. MOI smith fracture (reverse colles fracture) Fall/direct blow on DORSUM (top) of wrist/hand. 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. Type II: Fractures may also be intra-articular.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. 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. 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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