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What Is a Smith's Fracture?

By Apricus Health

20th December 2021

What is a Smith’s fracture? And what is the difference between a Smith, Colles and Barton fracture? Within this article, we’re going to outline the different types of fractures and what each fracture requires for successful treatment.

So, What Is a Smith's Fracture?

A Smith’s fracture is a fracture at the distal end of the radius bone in the forearm. It occurs as a result of a fall onto the palm of the hand, trauma that results in a volar (palm) displacement.

The correct diagnosis and management of a Smiths’ fracture is vital to preventing loss of normal wrist function, which can have serious implications on the functional status of your hand and overall quality of life. So, if you suspect a Smith’s fracture, it’s important to seek medical attention as soon as possible from a suitably qualified doctor, hand therapist, physiotherapist, or occupational therapist.  

Causes of a Smith’s Fracture

Now that we have an idea as to “what is a Smith’s fracture?”, it’s evident that this is a serious injury requiring proper management over time. This type of injury is typically caused by either a fall on a flexed wrist or a direct blow to the back of the wrist. Smith’s fractures are most commonly experienced by young males who have a high impact fall or elderly females after a low impact fall, usually as a result of osteoporosis.

Common scenarios for sustaining a Smith’s fracture are:

  • Tripping forwards while walking
  • Falling while cycling
  • Slipping backwards


A physical examination will usually reveal pain, swelling, a reduced range of motion and some disfigurement of the distal forearm. The angulation of the palm is often affected too, however, this is difficult to detect visually. It is at this stage that the nerves and circulation of the forearm need to be assessed, it’s likely that they’re affected.

Some research suggests that up to 15% of Smith’s fractures also exhibit symptoms of acute carpal tunnel syndrome due to compression of the medial nerve. Moreover, acute compartment syndrome is also associated with Smith’s fractures, a painful and dangerous condition caused by the build-up of swollen tissue in the area causing decreased blood flow, depriving the nerves and muscles of nutrients.

Diagnostic imaging will help assess the severity and exact location of a fracture, whilst an X-ray will show the degree of angulation and displacement and can help assess carpal malalignment, carpal fractures, and associated soft tissue injuries. If the fracture has occurred in multiple places thus producing multiple bone splinters, a CT scan can identify the pattern of the fracture and help plan if surgical correction is required.

If you’ve been wondering, “what is a Smith’s fracture?”, then you may not be aware there are a couple of other injuries commonly confused with a Smith’s fracture.

Colles vs Smith’s Fracture

A Smith’s fracture is sometimes also described as a reverse Colles fracture. A Colles fracture is a complete fracture of the radius bone close to the wrist resulting in an upward displacement of the radius and obvious deformity. Mostly known as a broken wrist, this kind of fracture is the result of a fall with an outstretched hand and, like a Smith’s fracture, is most common in young males and older females.

As younger patients have stronger bones, more energy is required to create a fracture and is often a result of high impact trauma from contact sports, skiing, horse riding, motorcycling or a fall from height. Older patients, particularly elderly females with osteoporosis are at high risk for this kind of injury. This is the most common of all types of fractures in women up to 75 years old.

Barton vs Smith’s Fracture

A Barton fracture is an intra-articular fracture of the distal radius, meaning it’s a fracture that crosses the joint surface, resulting in dislocation of the radio-carpal joint. The risk factors for a Barton fracture are very similar to those for both a Smith’s fracture and Colles fracture. One study found that 70% of patients presenting with a Barton fracture are male labourers or motorcyclists.  

Management of a Smith’s Fracture 

A stable Smith’s fracture can be treated with an open reduction (manipulating the bone back into place) and immobilisation with a splint or cast for four to eight weeks.  

After the immobilisation phase, hand therapy can help restore the full range of motion and strength to the wrist. Heat, massage, and prescribed exercises can support treatment to increase the range of motion and strength of the area.

If you’ve suffered any kind of fracture, or require hand therapy from an accredited therapist, feel free to book a discovery call with one of our team to get some pointers for your treatment and to learn how we might be able to support you.

With over 25 years-experience in allied health and five well-equipped, convenient locations across Townsville, Ingham and Ayr, Apricus Health are able to field any medical queries or concerns you might have!