Jewelry artifact is often just annoying but does not have any real impact on patient safety/care. However in a case like this it could potentially lead to a diagnosis being completely missed or misinterpreted. Although a (very) junior radiology trainee overlooked the fracture here, it was not missed by ED nor the final reporting radiologist.

However a smaller fracture could be missed and really greater efforts should have been made in the first place by the radiographer and ED staff to remove the bracelet in view of the relatively high pretest probability that a distal radius fracture might be present.

The Smith fracture was described by Robert Smith (1807-1873), a later Professor of Surgery at Trinity College, Dublin, who's immediate predecessor was Abraham Colles (after whom the Colles fracture was named)!