Smith fracture
Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fracture.
The term is sometimes used to describe intra-articular fractures with volar displacement (reverse Barton fracture) or juxta-articular fractures 1-3.
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Epidemiology
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.
Pathology
Smith fractures usually occur in one of two ways:
- a fall onto a flexed wrist
- direct blow to the back of the wrist
Radiographic features
The fracture can be split into three types, although in practice a description suffices 1,2:
-
type I
- extra-articular transverse fracture through the distal radius
- most common: ~85%
-
type II
- intra-articular oblique fracture
- equivalent to a reverse Barton fracture
- ~13%
-
type III
- juxta-articular oblique fracture
- uncommon: <2%
Plain radiograph
In most instances, a plain wrist radiographic series will suffice for diagnosis and characterization. The fracture line is usually evident, although in undisplaced of mildly impacted fractures it can be difficult to see and subtle cortical breaches/buckling should be sought. In intra-articular fractures (type II) the degree of articular step-off and gap should be assessed, and this may require CT.
Radiology report
Reporting checklist
In addition to reporting the presence of a distal radial fracture with volar angulation a number of features should be sought and commented upon:
- fracture
- location (extra-, juxta- or intra-articular)
- degree of angulation
- degree of displacement
- carpus
- ensure no carpal malalignment or fractures are present
- assess articulation of radio-lunate and radio-scaphoid joint
Treatment and prognosis
Treatment depends on the type of fracture, stability and ability to successfully reduce the fracture. In most cases, these fractures can be treated with closed reduction and cast application 1.
If the fracture can be reduced but remains unstable, or cannot be reduced then operative fixation (ORIF) is usually required 1.
Malunion, with a residual volar displacement of the distal radius results in a cosmetic deformity, referred to as a garden spade deformity. More importantly, it also narrows and distorts the entry to the carpal tunnel and can result in carpal tunnel syndrome 1.
History and etymology
First named for Jean-Gaspard-Blaise Goyrand, French physician (1746-1814) 4.
Named by Robert William Smith (1807-1873) who was a surgeon in Dublin, Ireland. He succeeded Abraham Colles (Colles fracture) as Professor of Surgery at Trinity College, Dublin.
See also
Related Radiopaedia articles
Fractures
-
fracture
- terminology
- fracture location
- diaphyseal fracture
- metaphyseal fracture
- physeal fracture
- epiphyseal fracture
- fracture types
- avulsion fracture
- articular surface injuries
- complete fracture
- incomplete fracture
- infraction
- compound fracture
- pathological fracture
- stress fracture
- fracture displacement
- fracture location
- fracture healing
-
skull fractures
- base of skull fractures
- skull vault fractures
-
facial fractures
- fractures involving a single facial buttress
- alveolar process fractures
- frontal sinus fracture
- isolated zygomatic arch fractures
- mandibular fracture
- nasal bone fracture
- orbital blow-out fracture
- paranasal sinus fractures
- complex fractures
- dental fractures
- fractures involving a single facial buttress
-
spinal fractures
- classification (AO Spine classification systems)
-
cervical spine fracture classification systems
- AO classification of upper cervical injuries
- AO classification of subaxial injuries
- Anderson and D'Alonzo classification (odontoid fracture)
- Levine and Edwards classification (hangman fracture)
- Roy-Camille classification (odontoid process fracture )
- Allen and Ferguson classification (subaxial spine injuries)
- subaxial cervical spine injury classification (SLIC)
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
-
cervical spine fracture classification systems
- spinal fractures by region
- spinal fracture types
- classification (AO Spine classification systems)
- rib fractures
- sternal fractures
-
upper limb fractures
- classification
- Rockwood classification (acromioclavicular joint injury)
- AO classification (clavicle fracture)
- Neer classification (clavicle fracture)
- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- AO/OTA classification of distal humeral fractures
- Milch classification (lateral humeral condyle fracture)
- Weiss classification (lateral humeral condyle fracture)
- Bado classification of Monteggia fracture-dislocations (radius-ulna)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
- Hintermann classification (gamekeeper's thumb)
- Eaton classification (volar plate avulsion injury)
- Keifhaber-Stern classification (volar plate avulsion injury)
- upper limb fractures by region
- shoulder
- clavicular fracture
-
scapular fracture
- acromion fracture
- coracoid process fracture
- glenoid fracture
- humeral head fracture
- proximal humeral fracture
- humeral neck fracture
- arm
- elbow
- forearm
- wrist
-
carpal bones
- scaphoid fracture
- lunate fracture
- capitate fracture
- triquetral fracture
- pisiform fracture
- hamate fracture
- trapezoid fracture
- trapezium fracture
- hand
- shoulder
- classification
- lower limb fractures
- classification by region
- pelvis
- hip
- Pipkin classification (femoral head fracture)
- Garden classification (hip fracture)
- American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)
- Cooke and Newman classification (periprosthetic hip fracture)
- Johansson classification (periprosthetic hip fracture)
- Vancouver classification (periprosthetic hip fracture)
- femoral
- knee
- Schatzker classification (tibial plateau fracture)
- Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture)
- tibia/fibula
- Watson-Jones classification (tibial tuberosity avulsion fracture)
- ankle
- foot
- Berndt and Harty classification (osteochondral lesions of the talus)
- Sanders CT classification (calcaneal fracture)
- Hawkins classification (talar neck fracture)
- Myerson classification (Lisfranc injury)
- Nunley-Vertullo classification (Lisfranc injury)
- pelvis and lower limb fractures by region
- pelvic fracture
- sacral fracture
- coccygeal fracture
-
hip
- acetabular fracture
- femoral head fracture
-
femoral neck fracture
- subcapital fracture
- transcervical fracture
- basicervical fracture
-
trochanteric fracture
- pertrochanteric fracture
- intertrochanteric fracture
- subtrochanteric fracture
- thigh
- mid-shaft fracture
- bisphosphonate-related fracture
- knee
- avulsion fractures
- Segond fracture
- reverse Segond fracture
- anterior cruciate ligament avulsion fracture
- posterior cruciate ligament avulsion fracture
- arcuate complex avulsion fracture (arcuate sign)
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture (MCL avulsion fracture)
- patellar fracture
- tibial plateau fracture
- avulsion fractures
- leg
- tibial tuberosity avulsion fracture
- tibial shaft fracture
- fibular shaft fracture
- Maisonneuve fracture
- ankle
- foot
- tarsal bones
- metatarsal bones
- phalanges
- classification by region
- terminology
Wrist pathology
- alignment
- wrist fractures and dislocations
- distal radial fracture
- pediatric
- carpal bones
- carpal instability
- osteonecrosis
- triangular fibrocartilaginous complex (TFCC) injuries
- ulnar-sided wrist impaction and impingement syndromes
- soft tissue and tendons
- arthritides