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Smith's Fractures

A Smith's fracture results from a fall on the bent or flexed wrist. The fracture is unstable and although can be treated by a Plaster cast only, it is generally operated upon because it is an unstable fracture.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

5-7 cm incision is made along the thumb side at the front (palm side) of the wrist. Mr Field always decompresses the carpal tunnel doing this operation through an additional wound in the palm this is because these fractures are often associated with a lot of swelling which can predispose to the development of carpal tunnel syndrome

The tendons are retracted and the muscle that the lies in front of the radius is cut to expose the fracture. With an X-ray machine in the operating theatre the fracture is manipulated back into position and a plate is applied to the proximal fragment (the part of the fracture nearest the arm). Screws are not necessary to be put into the distal fragment (the part of the fracture nearest the wrist) however sometimes they are.

POST OPERATIVELY

The arm is elevated over night and antibiotics are given to prevent infection. A plaster cast is generally applied and kept on for two weeks. The patient is seen at the two weeks stage and the plaster and stitches are removed and a formal cast is applied for a further four weeks.

COMPLICATIONS

  1. Infection - this is incredibly rare and in fact Mr Field has not seen it but it is feasible if one is inserting something from outside of the joint into the joint then one can introduce infection into the joint at that stage.
  2. Tendon damage.
  3. Nerve damage.
  4. Complex regional pain syndrome