Smith Fracture

By | June 10, 2022

A Smith’s fracture is a form of distal radius fracture. A fracture of the radius above the wrist is called a distal radius fracture. The spoke can invoice due to strong force.

What is a Smith fracture?

Smith’s fracture is a form of distal radius fracture. This is a rare form of fracture caused by a fall onto a flexed hand. The Smith fracture is therefore also referred to as a flexion fracture. The shape of the distal radius fracture may involve one or more fragments above the wrist.¬†For what does mediastinal emphysema mean, please visit

The fracture line runs about three centimeters above the wrist root. The fracture is more common in children, but adults and the elderly can also be affected. About 25 percent of distal radius fractures result in a specific type of fracture such as the Smith fracture.

If you fall on the back of your hand, the fracture is referred to as a so-called ‘Smith fracture’ or flexion fracture. A distal radius fracture is often associated with other injuries. Typical of this are injuries to the ligaments, fractures and dislocations of the carpal bones and nerve lesions. In addition, a distinction is made between an open and closed distal radius fracture.

An open fracture is when the fracture fragments injure the soft tissues and cause an open wound. An open fracture carries a significantly higher risk of infection and other complications during the healing process.


A Smith’s fracture occurs when you fall onto the back of your hand while your arm is outstretched. The fracture often occurs in children while playing, or in older people due to previous illnesses such as osteoporosis or general instability of the bone structure.

There is also an increased risk in older people, as they more often have unsteady gait, balance disorders, dizziness or cardiac arrhythmia and are more likely to fall. In middle age, general accidents or sports accidents with massive impacts are usually the cause of a distal radius fracture.

Depending on how the accident happened, two types of distal radius fracture are distinguished. A Colles fracture occurs in up to 90 percent of fractures. This is caused by a fall on the palm of the hand, resulting in an extension fracture. In rare cases, a fall on the back of the hand can also occur. The fracture fragment shifts in the direction of the back of the hand, which is then referred to as a flexion fracture or Smith’s fracture.

Symptoms, Ailments & Signs

Typical symptoms of a distal Smith’s fracture include painful swelling in the fracture area, misalignment and abnormal sequence of movements of the wrist, loss of strength and bleeding into the tissue. With a Colles fracture, the wrist is also shifted significantly downwards.

Basically, patients with a distal radius fracture have severe pain with limited or completely lost mobility. The movement sequences of pronation and supination (rotational movement) of the forearm are often restricted. In addition, neurological deficits and sensory disturbances can occur. An open fracture with protruding fracture fragments can occur if the force applied is massive.

Diagnosis & course of disease

A Smith’s fracture is diagnosed with certainty by a surgical or orthopedic specialist. The specialist medical assessment consists of the patient’s medical history, a physical examination and an imaging diagnostic procedure.

The patient’s medical history includes the course of the accident, any previous illnesses such as osteoporosis or previous injuries such as previous fractures in the affected area. During the physical examination, the specialist pays attention to possible non-physiological malpositions of the radius and sensitivity to pressure. Furthermore, the hand is examined neurologically for sensory and circulatory disorders.

The movement function of the proximal and distal radioulnar joints, as well as the wrist and finger joints is also part of the physical examination. X – rays or magnetic resonance imaging (MRI) can show the affected area and a possible fracture can be diagnosed with certainty.


First and foremost, a Smith’s fracture breaks a bone and causes extremely severe pain. Those affected may also lose consciousness and possibly injure themselves if they fall. Furthermore, in many cases the pain also spreads to the neighboring regions and can lead to sleep disorders at night and thus to psychological restrictions or depression.

Restrictions in everyday life and in the movement of the wrist also occur and significantly reduce the quality of life of those affected. Rotating movement of the arm is also significantly restricted by the Smith’s fracture. If there is no treatment, the nerves can also be damaged. The patients suffer from paralysis or limited sensitivity. Failure to immobilize the region can result in improper fusion.

As a rule, Smith’s fracture can be treated relatively well with a plaster cast. If the affected person still suffers from restricted movement after the bones have healed, therapy may be necessary. In most cases, the movement of the arm can be restored. There are no particular complications and the life expectancy of the person affected is not reduced by the Smith’s fracture.

When should you go to the doctor?

A Smith’s fracture should be treated promptly by a doctor. After an accident with a broken bone, it is important to alert the emergency doctor and to calm the injured person. Depending on the severity of the injury, first aid measures must be provided on site. Smith’s fracture is initially treated by an ambulance. The victim must then be treated in a hospital. In the case of serious injuries, intensive care of the patient is necessary in any case.

Emergency surgery may also need to be performed, depending on the severity of the injury. After the initial treatment, the patient must take advantage of the regular follow-up checks by the general practitioner or orthopedist. Any functional limitations must be compensated for by physiotherapeutic treatment. The doctor should also be informed of any side effects. If the pain or other symptoms persist, it is best to consult your family doctor. The doctor can rule out serious complications and prescribe appropriate medication. Major complications of bone fusion need to be evaluated and treated by a specialist.

Treatment & Therapy

If a Smith fracture, i.e. a distal radius fracture, has been diagnosed, the specialist will decide on the basis of the findings whether conservative or surgical treatment is required. Conservative therapy is indicated if the fracture is simple and uncomplicated. An uncomplicated fracture is when the wrist is unaffected and the fracture fragments are not displaced.

Even if the fracture fragments can be repositioned manually, it is referred to as a simple fracture. The forearm is then immobilized in a plaster cast or in a soft cast for four to six weeks. Regular X-rays should be taken during immobilization.

Surgical treatment of Smith’s fracture is necessary if the fracture is complicated. A compound fracture is when the wrist is involved, the fracture fragments have shifted or separated, and the fracture is multi-fragment. During the surgical intervention, the fracture fragments are realigned anatomically and then fixed with a screw or plate osteosynthesis.

Postoperatively, the forearm is immobilized and the healing process is monitored by regular X-rays. The aim of conservative and surgical therapy is always freedom from pain and the fastest possible restoration of the anatomical function in the wrist and in the distal radioulnar joint.

Immobilization should be kept as short as possible and mobilization started early to prevent muscle atrophy and irreversible movement restrictions. After about a year postoperatively, the implants can be removed again using a minimally invasive procedure.


In principle, a fall cannot be prevented. However, if you are aware of unsteady gait or dizzy spells, this should be clarified by a doctor and, if necessary, treated.


Follow-up treatment of Smith’s fracture must be carried out after both conservative therapy and surgical intervention. The fracture of the wrist is usually immobilized with a cast for four to six weeks. As part of conservative aftercare, the forearm cast is removed after about six weeks.

This is followed by intensive physiotherapy and occupational therapy exercises, which are very important for the further healing process. After the wrist has been immobilized for a long time, its strength and mobility can only be fully restored by these measures.

If the Smith’s fracture was treated with a titanium plate as part of the operation, physiotherapy exercises are possible just one day after the surgical intervention. The early functional exercises can be used to counteract prolonged immobilization of the forearm. At the same time, the loss of muscle mass can be avoided, so that the previous range of movement can be reached sooner.

If the patient is discharged from the hospital, it is important that he continues the physiotherapeutic exercises at home independently and regularly. The exercises are considered the most important aftercare measure to achieve rapid healing progress. Also important for the follow-up treatment of the Smith’s fracture are the regular changing of the cast and the taking of X-rays in order to monitor the course of the healing process. It is also important to actively mobilize the shoulder and elbow joints during the long period of immobilization.

You can do that yourself

In order to improve the healing path and optimize recovery, the person affected should never put any weight on their injured hand. Movements are also to be reduced to a minimum. In everyday life, the fulfillment of the various duties must therefore be restructured. The help of other people from the social environment should be used so that no complications or disturbances arise during the healing period.

Sporting activities should be kept to a minimum and should exclude hand movement. The gripping function of the fingers should remain as unused as possible during the healing process. If the hand is loaded too early, the situation can worsen.

In an advanced stage of recovery, it is helpful to use physiotherapeutic exercises to rebuild the muscular system. Loading the injured hand too early can lead to a relapse. Balancing movements help in the event of circulatory disorders. In addition, adopting a rigid posture should be avoided. As soon as numbness in the hand or sensory disturbances appear on the skin, balancing movements should be carried out slowly. The blood circulation must be stimulated in order to alleviate the symptoms. Especially at night, make sure that the affected hand is immobilized if possible.

Smith Fracture