There are many different types of wrist fractures. A Smith fracture is not your typical broken wrist. It only makes up about 5% of all of wrist fractures. Read on to learn more about Smith fractures. Let’s start with anatomy.
The wrist
The wrist is made up of 3 joints. These include the distal radioulnar joint, radiocarpal joint, and the midcarpal joint. The distal radioulnar joint is made up of the ends of the forearm bones, the radius and ulna, at the wrist. This joint is essential for supination and pronation. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radiocarpal joint is made up of the radius and the first row of carpals. Carpals are the small wrist bones in between the forearm bones and the hand bones. The first row of carpals includes the scaphoid, lunate, and triquetrum. The pisiform is also in this row of carpals, but it is not part of the joint. It sits on top of the triquetrum. This joint is the dominant joint for wrist extension. It assists in wrist flexion, radial deviation, and ulnar deviation.
Wrist extension is when the back of the hand moves toward the back of the forearm. Wrist flexion is when the palm of the hand moves toward the forearm. Radial deviation is when the hand moves to the thumb side. Ulnar deviation is when the hand moves towards the little finger side.
The midcarpal joint is the joint made up of the first and second row of carpals. The second row of carpals include the trapezium, trapezoid, capitate, and the hamate. This joint assists in wrist extension and ulnar deviation. It is the dominant joint for wrist flexion and radial deviation.
What is a Smith fracture?
A fracture is just the medical term for broken bone. A Smith fracture is when the radius breaks near the wrist joint. What makes this fracture different is the angulation of the fractured piece of bone. The bone will be displaced or angled toward the palm side of the wrist. This type of fracture typically occurs after:
- Fall onto a flexed wrist
- Direct blow or trauma to the back of the wrist
- Fall onto the palm of the hand
Fractures of the radius near the wrist are the most common type of fracture in the upper extremity. This includes the shoulder, arm, elbow, wrist, and hand. However, Smith fractures make up only 5% of all radius fractures near the wrist. They typically occur from high energy falls in kids or low energy falls in the elderly.
What are the symptoms of a Smith fracture?
There are several symptoms associated with a Smith fracture. These include:
- Pain and swelling at or near the wrist
- Deformity in the forearm near the wrist
- Decreased mobility of the wrist
- Bruising in the area
Will I need surgery?
The answer is maybe. If the fracture is non-displaced and stable, then it can be put in a cast or splint. If the fracture is minimally displaced, then it can be reduced (positioned correctly) and then placed in a cast or splint. The wrist is usually in a cast for 4-8 weeks. Surgery would probably be necessary if the fracture is significantly displaced, has a significant angulation, goes into the joint, or is in multiple pieces.
What are some possible complications of a Smith fracture?
There are several possible complications associated with a Smith fracture. These include:
- Malunion – This occurs when the bone heals in an abnormal position. This new position could block the carpal tunnel and cause carpal tunnel syndrome.
- Entrapment of the extensor pollicis longus tendon – The extensor pollicis longus is a muscle that helps move the thumb. It can become entrapped in the area of the fracture.
- Complex regional pain syndrome – This is a complex pain disorder that can affect an area of injury. It is characterized by pain that is greater than would be expected from the injury.
Who should I see?
- Physician – If you suspect that you have sustained a Smith fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this fracture should be treated quickly. However, if your fracture has already been treated and you suspect additional injury or complication, then it would be best to see your orthopedist or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy will be needed to regain mobility and strength in the wrist. This will be true whether or not surgery was needed. Because of the time in the cast or splint, the wrist will be stiff and sore when trying to move or use it. Your PT can evaluate you to determine the extent of your mobility and strength deficits and use manual therapy, as well as, stretching and strengthening to help address all problems in and around the wrist.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking or jogging while your wrist is healing.
- Ice – Ice can help decrease pain and symptoms at the wrist. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- The following are activities that you can do after the cast is removed or you are cleared by your surgeon.
- Wrist flexion and extension stretching – You will need to stretch out the wrist flexors and extensors.This will feel very tight and sore at first. Begin with a gentle stretch. You can stretch more aggressively as the soreness subsides. See the video below.
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- Wrist strengthening – It is important to strengthen the wrist after a long period of immobilization. Begin with low to no resistance and slowly increase as it becomes easier. You should have minimal pain when performing the exercise and no pain afterwards. Below is a video showing how to strengthen the wrist using resistance bands.
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- Grip strengthening – Strengthening the muscles for gripping is important since a Smith fracture can affect this action. Performing gripping exercises is helpful for recovering hand strength. See the video below.
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- Strengthening the muscles around the elbow and shoulder – Strengthening the muscles around the elbow and shoulder are also important in being able to return to your activity. Decrease your resistance or number of repetitions if you are having pain in the wrists. Using loop resistance bands, dumbbells, or resistance bands can increase strength and difficulty. See the videos below.
In review
- The wrist is made up of 3 joints.
- These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint.
- Carpals are the small wrist bones in between the forearm bones and the hand bones.
- A Smith fracture is when the radius breaks near the wrist joint.
- The bone will be displaced or angled toward the palm side of the wrist.
- There are several symptoms of a Smith fracture including pain at the wrist, deformity of the wrist, and decreased wrist motion.
- There are several complications that could occur including malunion.
- Surgery might be required depending on the stability and displacement of the fracture.
- There are things that you can do.
- Rest
- Ice
- After surgery or cast is removed
- Wrist flexion and extension stretching
- Wrist strengthening
- Grip strengthening
- Elbow and shoulder strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Smith%27s_Fracture
https://www.osmosis.org/answers/Smiths-fracture