Smiths Fracture

What is Smiths Fracture

Smiths Fracture is a specific type of break in the main bone of your forearm (radius). The radius is the long bone on the same side as your thumb. A Smith’s fracture occurs near the wrist and causes the radius to move out of place, toward the palm of your hand.

What are the causes?

This condition may be caused by:

• Falling with your arm outstretched.
• A hard, direct hit to the wrist.

What increases the risk?

You may be at higher risk for this type of fracture if you:

• Are a young child or an older adult.
• Play contact sports or high-risk sports, such as skiing, biking, or ice-skating.
• Have a condition that causes the bones to become thin and brittle (osteoporosis).

What are the signs or symptoms?

A Smith’s fracture causes pain that gets worse when you try to move your wrist. Other signs and symptoms may include:

• Bruising.
• Swelling.
• Your wrist having an abnormal shape (deformity).
• Inability to move your fingers.
• Numbness in your hand.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• X-rays.

How is this treated?

Treatment depends on how severe your fracture is and how the pieces of the broken bone line up with each other (alignment).

• If your broken bone is in good alignment, you will need to wear a splint or cast for several weeks.
• If your fracture is severe and the broken bone is not aligned (is displaced), your health care provider will need to align the bone pieces. After alignment, you will need to wear a splint or cast for up to 6 weeks. To align your broken bone, your health care provider may:
  • Move the bones back into position without surgery (closed reduction).
  • Perform surgery to align the fracture and fix the bone pieces into place with metal screws, plates, or wires (open reduction and internal fixation, ORIF).
  • Perform surgery to align the fracture and fix the bone pieces into place with pins that are attached to a stabilizing bar outside your skin (external fixation).

Treatment may also include:

• Physical therapy.
• Follow-up visits and X-rays to make sure you are healing.

Follow these instructions at home:

Early Care During Immobilization

Even while the wrist is immobilized, it is important to maintain mobility in adjacent joints:​

• Movement of fingers should be encouraged to maintain mobility and assist lymphatic drainage
• Shoulder and elbow range of motion exercises are encouraged to prevent stiffness
• Hand elevation to manage swelling
• Application of heat or cold therapy as tolerated to manage pain and inflammation

If you have a splint:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
• Keep the splint clean and dry.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean and dry.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• If your splint or cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything with your affected arm.
• Do physical therapy exercises as told by your health care provider.

Managing pain, stiffness, and swelling

• If directed, put ice on painful areas:
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag, or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) your wrist above the level of your heart while you are sitting or lying down.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened, if applicable. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive until your health care provider approves. You should not drive or use heavy machinery while taking prescription pain medicine.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• Pain that does not get better with medicine.
• Swelling that gets worse.
• Fever or chills.
• A bad smell coming from your cast.

Get help right away if:

• You have tingling or severe pain when you move your fingers.
• Your fingers or your hand:
  • Become numb, cold, or pale.
  • Turn a bluish color.
• You cannot move your fingers.

Summary

• A Smith’s fracture is a specific type of break in the main bone of your forearm (radius).
• A Smith’s fracture occurs near the wrist and causes the radius to move out of place, toward the palm of your hand.
• If your broken bone is in good alignment, you will need to wear a splint or cast for several weeks.
• If your fracture is severe and the broken bone is not aligned (is displaced), your health care provider will need to align the bone pieces. That may or may not require surgery. You will then need to wear a splint or cast for up to 6 weeks.