Smith Fracture

What is a Smith fracture?

A Smith fracture is a specific type of broken wrist. It’s caused by falling or experiencing another trauma while your wrist is bent or flexed.

There are lots of different bone fractures, and it’s easy for the different names to sound confusing. For example, you may see Smith fractures referred to as a type of distal radius fracture. The radius is one of the bones in your forearm, and its distal end is toward your wrist.

Each of the specific details you might read or hear about tells your healthcare provider which bones are broken, where they’re broken, how they broke and what they look like inside of your wrist right now. Think about all these names for fractures like the magnification settings on a microscope that helps your healthcare provider zoom in on your specific injury. No matter which names and terms are applied to your injury, the most important first step is getting your wrist examined by your healthcare provider as soon as possible.

What is the difference between a Smith fracture and other wrist fractures?

The type of wrist fracture you have depends on how your bones broke and what the break itself looks like. Smith fractures usually come from falling with your wrist closed or flexed inward, or from a direct blow to the back of your hand.

Smith fracture vs. Colles fracture

If you’re diagnosed with a Colles fracture, the broken piece of your wrist bone (radius) points backward. Smith fractures are the opposite: The broken end of your bone points forward.

Smith fracture vs. Barton fracture

Barton fractures are similar to Smith fractures — they both usually come from falling on your wrist when it’s closed or flexed in. But with Barton fractures, your broken bones angle up or away from your palm.

Who gets Smith fractures?

Smith fractures can happen to anyone because they’re usually caused by an accident or trauma.

One important risk factor is osteoporosis. If you have osteoporosis, your bones are more susceptible to fractures. Anyone can develop it, but women are four times more likely than men. People older than 50 are also at an increased risk of osteoporosis.

How common are Smith fractures?

Wrist fractures, in general, are 20% of all broken bones treated in emergency rooms, and the second most common broken bone in adults older than 50.

Compared to other types of wrist breaks, Smith fractures are rare. They’re only around 5% of all broken wrists.

What are the symptoms of Smith fracture?

Symptoms of Smith fracture include:

• Wrist pain.
• Swelling.
• Tenderness.
• Inability to move your wrist without pain.
• Bruising or discoloration around your wrist.
• Unusual deformity or bump on your wrist that’s not usually there.

What causes a Smith fracture?

Falls are by far the most common cause. Most people diagnosed with a Smith fracture landed on the back of their wrist with their hand flexed or bent in toward their body.

Car accidents, sports injuries and other significant traumas also cause Smith fractures.

You might see the cause of your broken wrist referred to as the “mechanism for injury.” This is just the medical term for “cause” and helps your healthcare provider know how you were hurt.

How is it diagnosed?

A Smith fracture is diagnosed with an X-ray. This tells your healthcare provider which of your bones are broken and which type of fracture you have. All broken wrists require an X-ray.

In addition to confirming your broken wrist, the X-ray will give your healthcare provider important information such as how clean the break is or how many pieces there are, how much space there is between your bones and whether other bones are damaged, too.

In some cases, you might need other imaging tests like a CT scan or MRI to confirm or rule out damage to other parts of your wrist, like muscles, tendons and ligaments.

Which tests you’ll need will depend on the cause and severity of your injury. You’re more likely to need extra imaging if your wrist was fractured in a more dangerous trauma like a car accident or falling off a ladder.

How is a Smith fracture treated?

How your Smith fracture is treated depends on the severity of the original break. Your broken bones need to heal back together, and there are several ways to make sure they’re repaired correctly.

Immobilization

If your break is mild and your bones didn’t move far out of place, you might only need a splint or cast. Splinting usually lasts for three to five weeks. If you need a cast, it’ll likely be longer, typically six to eight weeks. You’ll also likely need follow-up X-rays to make sure your bones are healing correctly.

Closed reduction

More severe breaks require a closed reduction to set (realign) your bones. During this nonsurgical procedure, your healthcare provider will physically push and pull your arm and wrist to line up your broken bones. To prevent you from feeling pain during the procedure, you’ll receive one of the following:

• Local anesthetic to numb your wrist and arm.
• Sedatives to relax your whole body.
• General anesthesia to make you sleep through the procedure.

After the closed reduction, your healthcare provider will put your wrist in a cast or splint, and you’ll need a follow-up appointment with a specialist to discuss your treatment options.

Smith fracture surgery

The most intense fractures require surgery. Your surgeon will repair your broken bones and insert a metal plate and screws into your wrist to hold it together.

Recovery time for surgery is longer than other methods. You’ll need a splint following surgery to help protect your bones and help them heal. You’ll also require physical therapy to help you regain your strength and mobility.

What medications/treatments are used?

Talk to your healthcare provider before taking any medications to reduce pain after any treatment. Over-the-counter pain relievers (such as ibuprofen or acetaminophen) may reduce pain and swelling.

How can I prevent a Smith fracture?

Breaking your wrist almost always happens accidentally. Because falls are by far the most common cause of wrist fractures, make sure your home and workspace are free from clutter that could trip you or others. Make sure the adults older than 50 in your life practice good fall prevention, too.

Talk to your healthcare provider about osteoporosis and how you can prevent bone loss with the right diet, exercise routine and regular bone density screening, as well.

How long does it take a Smith fracture to heal?

Healing time depends on the severity of your fracture and which treatments you needed. It can take anywhere from a few months to more than a year to recover.

• Splinting and casting: Around six weeks.
• Closed reduction: You’ll be able to go home the same day you have the procedure and will need a splint/cast for at least six to eight weeks if you don’t need surgery.
• Surgery: It’ll take between one and three months to recover from surgery. You’ll also need four to six weeks of rehab.

Many people will experience stiffness and pain in their wrist that can last for months or even years after their fracture heals.

When can I go back to work/school?

Regardless of which kind of treatment you need, a Smith fracture will impact your life while you heal:

• It may be hard to read, write or use a computer, especially if you broke the wrist on your dominant side.
• If you had surgery, you’ll need physical therapy before regaining your strength.
• Even if you don’t need surgery, your healthcare provider will give you an exercise routine to help you maintain your hand and wrist’s range of motion and flexibility.

Your healthcare provider will also help you understand how long you’ll need to miss work, school or other activities while you heal.

Most people can return to light exercise (walking, jogging, lower body workouts) a month or two after having their cast removed or after surgery. It can take as long as six months before you’re able to resume intense activity like heavy workouts or contact sports, though.

What are complications of Smith fractures?

Smith fracture complications can include:

• Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage.
• Malunion: This happens when your broken bones don’t line up correctly while they heal.
• Carpal tunnel syndrome: A broken wrist that doesn’t heal properly may lead to carpal tunnel syndrome, which causes pain, numbness and weakness in the affected hand.
• Bone infection (osteomyelitis): If you have an open wrist fracture (the bone breaks through your skin), you have an increased risk of bacterial infection.
• Other internal damage: Fractures can damage the area around your injury, including your muscles, nerves, blood vessels, tendons and ligaments.

When should I see my healthcare provider or go to the emergency room?

If you think you have a wrist fracture, get help right away. Go to the emergency room if you’ve experienced a trauma and have any of the following symptoms:

• Intense pain.
• Swelling.
• Tenderness.
• You can’t move your wrist.

Make sure you tell your healthcare provider or the emergency responders everything that happened.

What questions should I ask my healthcare provider?

• What kind of fracture do I have?
• Will I need to wear a splint or cast?
• Do I need surgery?
• Will I require physical therapy?
• How soon can I use my broken wrist?
• When can I play sports or work out?
• When will my wrist be completely healed?

A note from Cleveland Clinic

Breaking a bone is always scary, especially if it happens during a traumatic event. Fortunately, wrist fractures are treatable, and most people are able to resume all the activities they enjoyed before their injury. If you think you have a Smith fracture, or any other kind of broken wrist, get it examined as soon as possible. If you have specific risk factors like osteoporosis, make sure you talk to your healthcare provider about how you can keep your bones strong to prevent fractures.