Smith’s fracture

1. Forearm Case 3

2. History and Physical 51 male working at construction site when he slipped and fell backwards, breaking his call with his outstretched arm behind him, palm down. Pt states with instant pain to right wrist/forearm, with no other injuries. T 98.3 P 88 BP 160/94 O2 99% Gen: Age appropriate male, obvious pain, NAD MSK- Pt with swelling to right wrist, obvious deformity to ventral surface but no laceration. Radial pulse 1+ on right Neuro : pt with limited extension/flexion at right wrist secondary to pain; no sensory abnormalities

3. Radiographs

4. Diagnoses: Smith’s Fracture Distal Radius Fx with volar angulation of distal fragment

5. Pain control C losed reduction by reversing fx deformity w/ longitudinal traction Ortho consult, as many will require Operative reduction/fixation If immediate consult not available, may place in long arm splint with forearm supinated, wrist in neutral or slightly extended, with follow up in next 48 hours           ED Management

6. Extra-articular palmarly displaced distal radius fx   V olar angulation of fx is referred to as "Garden Spade" deformity (reversed Colles Fracture) Mechanism:      - backward fall on the palm of an outstretched hand causing pronation of upper extremity while the hand is fixed to the ground Classification:      - Type I:   extra articular;      - Type II:  crosses into the dorsal articlar surface;      - Type III: enters radiocarpal joint             - Volar Barton's Fracture = Smith's type III Pearls

7. More Images

8. http://www.wheelessonline.com/ortho/smiths_fracture http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/wrist/case62/case62background.html http://www.medcyclopaedia.com/library/radiology/chapter13/13_5/13_5_1.aspx http://www.netterimages.com/image/12833.htm https://www.imeducate.com/wp-content/uploads/2010/04/Smith_AP_LAT.jpg References