Case 33: A different kind of FOOSH injury
Monday, October 10th, 2011Author: Dr Danielle Coleman
(Click on image to enlarge)
This was the xray taken of the left wrist of an elderly lady after she fell down whilst out shopping.
1. What is the eponymous name of this fracture?
Click to see the answerThis is known as a Smiths fracture after the orthopaedic surgeon Robert William Smith after it was described in his book – A Treatise on Fractures in the Vicinity of Joints, and on certain forms of Accidents and Congenital Dislocations in 1847. It is also described as a reverse Colles fracture. This is because the distal fragment of the fracture is displaced ventrally, which is opposite to the more commonly occurring Colles where the fragment is dorsal.
2. What is the most common mechanism of injury?
Click to see the answerThis usually occurs from a fall onto a backwards outstretched hand causing pronation of the arm with the hand fixed onto the ground.
3. Is this fracture managed in a POP backslab?
Click to see the answerNo, this is inherently an unstable fracture and therefore the management of choice in this injury is internal fixation, particularly if the fracture extends into the joint space. The fracture should be manipulated in the Emergency Department to a close approximation of an anatomical position as possible with longitudinal traction and a long arm cast with the wrist in extension. This can then be fixed at orthopaedic leisure.