Smith Fracture or Reverse Colles Fracture: Causes, Symptoms, Treatment- Surgery, PT
Smith Fracture is also termed as Reverse Colles Fracture. This is caused when there is rupture in the end of radial bone located near wrist. This type of fracture typically occurs after falling down on an outstretched arm and landing on the back side of wrist and hand which results in breaking of radius bone at its end and pushing it towards the front side of outer wrist.
Types of Smith Fracture or Reverse Colles Fracture
Smith Fracture Can Broadly Be Classified Into Two Types
- Nondisplaced Fracture: This is frequently called as mild fracture. The treatment for this condition is done by casting. Once the problem is diagnosed immediate attention must be given. The area of the fracture gets healed in few weeks.
- Displaced Fracture: This type of fracture is very severe in nature. Displaced fracture generally leads to very serious and dangerous damage to the bone. In this condition the joint of the wrist is often displaced forward creating discomfort for the ball while moving in some angles.
Smith fracture can also be classified into three types based on the type of injury sustained.
- Type 1- Oblique comminuted fracture usually seen in older women.
- Type 2- Barton's fracture.
- Type 3- A more transverse fracture usually seen in young individuals due to severe injury.
Causes of Smith Fracture or Reverse Colles Fracture
- Smith fracture often results from direct trauma to the back of the wrist, like a direct blow from a stick, as in lacrosse and hockey.
- Smith fracture is also caused with falling down on a flexed wrist.
Signs and Symptoms of Smith Fracture or Reverse Colles Fracture
- Typically acute pain in the wrist from an impact or a fall.
- Tenderness in the affected area.
- Difficulty while moving the wrist.
- Wrist may become deformed.
- Appearance of hand being angled downwards.
- Pain is felt during movements of the wrist.
- Development of swelling.
- Fractured bones may create a cracking noise.
- Symptoms of fever few hours after the injury.
Treatment for Smith Fracture or Reverse Colles Fracture
In very few cases there is just a displacement or deviation of bone from its normal position. This may affect use of arm or wrist. This can be treated with manipulation and reduction. Conservative measures involve closed reduction with use of local anesthesia and then casting of hand and thumb. It takes about ten weeks for complete recovery, which involves period of immobilization for about a month and then splinting for some six weeks.
Surgical Treatment: Surgery is needed in majority of cases to treat Smith fracture as the deformity cannot be treated with nonsurgical means. This method is termed as open reduction.
This is done by creating an incision for interpretation of fracture and to get it back to its normal place. This at times requires hardware like pins, screws, etc.
The risks of surgery include but are not limited to infection, bleeding, hardware failure etc.
Physical Therapy (PT): This is essential for everyone for appropriate healing and normalize function of wrist and hand and can include:
- Joint mobilizations.
- Soft tissue massages.
- Ice and heat.
- Therapy focusing on improved strength.
- Activity modifications.
- Attempts at returning to activity.
Exercises for Smith Fracture or Reverse Colles Fracture
- Elbow Bend-to-Straighten: This is done by bending and straightening elbow until painless stretch is sensed. Try and repeat about 15 times without exacerbating symptoms.
- Wrist Bends: This is done by putting forearm on an object with wrist on the edge. The, try and bend wrist forward and backward until painless stretch is sensed. This should be done 10 times without aggravating symptoms.
- Forearm Rotations: This is done with elbow on the side and bent at right angles. Now, the palm is rotated upwards and downwards as much as possible until painless stretch is sensed. Attempt to do this 15 times without increasing symptoms.
- Wrist Side Bends: This is done by placing forearm on an object with wrist on the edge of it. Now try and bend the wrist sideways as far as you can until painless stretch is sensed. Try and do this 15 times.
Investigations for Smith Fracture or Reverse Colles Fracture
- X-ray of the wrist.
- CT scan in rare cases.
- MRI in rare cases.