Smith's Fractures Research Articles

Operative treatment of Smith-Goyrand fractures

Optimal treatment of Smith's fracture remains controversial. Conservative management of type III fractures is acceptable, but results are moderate for types I and II. This study includes 53 patients operated on during the past 10 years; six of type I, 17 of type II and 30 of type III. The functional end result was good in 32 cases (60.3 per cent) and excellent in nine cases (16.9 per cent). Functional results of types I, II and III were comparable when the excellent and good groups were added together. There was no correlation between anatomical result and functional outcome (κ = 0.07), although a good anatomical result usually accompanied a good to excellent functional end result. Operative treatment of Smith's fractures have good functional end results in our hands, regardless of the fracture type.

両側どう骨遠位端骨折の治療経験

Fifteen patients with bilateral distal end fractures of the radius were treated from August 1984 to March 1989.There were 11 males and 4 females. The mean age was 24.9 years with a range from 9 to 83 years. The types of fractures were 17 Colles' fractures, 11 Smith's fractures and 2 Chauffeur's fractures. The mechanism of injury was high energy trauma in most cases.Before 1986 treatment by fixation with a plaster cast after manipulation was performed in our hospital, but percutaneous pinning has been prefered since 1986.The results of percutaneous pinning were satisfactory.

Transverse posterior element fractures associated with torsion.

Six examples of a previously undescribed class of transverse vertebral element fractures are presented. These fractures differ from Chance and Smith fractures and their variants in the following respects: (1) the etiology is torsion and not flexion; (2) there is neither distraction of posterior ring fragments nor posterior ligament tears; (3) in contrast to Chance and Smith fractures, extension of the fracture into the vertebral body is absent or minimal; (4) the transverse process of the lumbar vertebra is avulsed at its base with a vertical fracture, not split horizontally. These fractures occur in cervical, lumbar, and sacral vertebrae in normal or compromised areas of the spine.

Barton's and Smith's Fractures

Smith's and Barton's fractures are discussed in light of their original descriptions and current experience. Included here are excerpts from the original descriptions of Smith and Barton as well as the management of these two kinds of fracture.

Simultaneous fractures of the distal radius and scaphoid.

Simultaneous fractures of the distal radius and scaphoid are uncommon injuries for which the treatment is controversial. Nine patients with these fractures are presented. Five patients were available for long-term followup. In the series, there were five Colles and four Smith's fractures of the distal radius. All scaphoid fractures occurred at the anatomic waist. All injuries resulted from falls of considerable force producing hyperextension at the wrist. The ages of the patients ranged from 21 to 90 years (median, 34). All fractures were placed in a thumb spica cast with the wrist in neutral position. Five fractures required a second reduction of the radius and were placed in external skeletal fixation. No scaphoid fracture was displaced by this treatment, and all scaphoid fractures progressed to union. The principal deformity at followup was an average 16 degrees loss of volar tilt. Residual pain or functional disability was not noted. We conclude that these fractures can be successfully treated by reduction of the radius and immobilization by whatever means necessary to maintain an acceptable position. Scaphoid reduction and healing seemed unaffected by the method of treatment used to treat the distal radius fracture in this series.

Extensor tendon involvement in Smith's and Galeazzi's fractures

Extensor tendon involvement in three Smith's and two Galeazzi's fractures are reported. In two cases of previous Smith's fracture, the extensor indicis proprius tendon had been entrapped and ruptured in one case, and in the other the extensor digitorum communis tendon of the index was pierced by the fragment. Both showed a severe tenodesis effect on the index finger and thumb. In a new case of Smith's fracture, long extensor tendons of the fingers and thumb had been trapped beneath a dorsally displaced third fragment making closed reduction impossible. In the two cases of Galeazzi's fracture; in one the extensor carpi ulnaris tendon was trapped between the dorsally displaced ulnar head and the avulsed styloid process and in the other, the extensor digiti minimi tendon was caught beneath the radial border of the dorsally dislocated ulnar head.

The Y-shaped Plate for the Fractures around the Joint

The Y-shaped plate designed by us was used for Barton's fracture initially, to compress the fragmented volar edge of the radius by two limbs of the plate, which was fixed to the shaft by one or two screws.The plate was also applied to Smith's, comminuted Colles, tibial plateau and ankle fractures. Four week's immobilization was performed for the fractures of upper extremities, six week's immobilization for the fractures of the lower extremities. We could obtain good results in most cases except for open fracture of the wrist which caused adhesion of the tendon.

Treatment of Smith fractures (author's transl)

A full description of the different types of Smith fractures following Thomas classification is given, together with the guidelines of treatment of each type. Conservative treatment is usually sufficient for types I and III, provided that reduction is anatomic and stable. The indication for internal fixation is given for all type II and unstable type III fractures. An exact description of the volar buttressing technique with the AO-T-plate is presented.

A REVIEW OF SMITH'S FRACTURES

1. Forty-four cases of Smith's type fractures are reviewed and emphasis laid upon the significance of the different fracture types. 2. Treatment is reviewed and recommendations made for future management.

Smith's fracture. A review.

Although an uncommon injury, Smith's fracture is a fracture around a wrist joint which must be remembered in all injuries in this vicinity. Its diagnosis was missed in 75 per cent of cases in this series. Smith's fractures fall into 4 distinct types as determined by the patient's age and X-ray appearances. It is suggested that all Smith's fractures should be reduced with the hand in maximum supination, in an above-elbow plaster cast, for six weeks. Even when adequately treated, all patients are left with some disability, but this is very much less than in those where the diagnosis is missed or the fracture treated as a Colles' fracture, or treated by open reduction.

Clinical experiences with a series of Smith's fractures.

The uncommon fracture of the distal radius originally described by Smith in 1847 has received surprisingly little attention. Apparently the hiatus in the literature extends from the time of Smith's essay to the contribution of F. Brian Thomas in 1957. 7 Incidence Most standard textbooks of orthopedics 1,8 indicate that the actual incidence of this fracture has not been accurately assessed. Thomas included 19 cases collected over a 3-year period. Some idea of how frequently the lesion is seen in a private orthopedic practice is provided by a recent tabulation of 20 years of fracture experience in a report by Emmett 2 and associates in which there were 448 Colles' and only 23 Smith's fractures in instances where the distal end of the radius was involved. The latter represents less than 1% of a total of approximately 11,000 fractures seen by this group during this period. Annually, 1,800 to 2,000

Reduction of Smith's fracture.

A classification of Smith's fractures into three types is proposed. It is suggested that the majority of these fractures are caused by a pronation injury. The reduction of Smith's fractures by supination is described and the importance of the supinated position during splintage is stressed.