This document summarizes different types of distal radius fractures, including Colles fractures and Smith fractures. Colles fractures involve a hyperextended and radially deviated wrist from a fall, often appearing as a "dinner fork" deformity. Smith fractures are the reverse with volar angulation from the wrist flexed in a fall. Treatment options are also summarized, indicating nonoperative treatment for nondisplaced or minimally displaced fractures using splinting or casting, while operative indications include displaced articular fractures, nerve injuries, or multiple injuries. Nonoperative techniques involve closed reduction and splinting or casting the wrist in slight flexion for 6 weeks.

1. DISTAL RADIUS
FRACTURE

2. Colles fracture
o Described as a “dinner fork” deformity.
o More than 90% of distal radius fractures are of this pattern
o Mechanism of injury is a fall onto a hyperextended,
radially deviated wrist with the forearm in pronation.
o Intra-articular fractures are generally seen in the younger
age group secondary to higher energy forces
DISTAL
RADIUS
FRACTURES

3. Smith fracture
(reverse Colles fracture)
o Fracture with volar angulation (apex dorsal) of
the distal radius with a “garden spade”
deformity.
o Mechanism of injury is a fall onto a flexed wrist with the forearm
fixed in supination.
o Notoriously unstable fracture pattern; it often requires open
reduction and internal fixation
DISTAL
RADIUS
FRACTURES

4. Basic Baby Care
NONOPERATIVE
Indications:
• Nondisplaced or minimally displaced
fractures
• Displaced fractures with a stable fracture
pattern which can be expected to unite
within acceptable radiographic parameters
• Low-demand elderly patients in whom
future functional impairment is less of a
priority than immediate health concerns
and/or operative risks
OPERATIVE
Indications:
• High-energy injury
• Secondary loss of reduction
• Open fractures
• Displaced shear fractures (type II)
• Comminuted and displaced articular fractures with
articular impaction (type III)
• Fracture–dislocations (type IV)
• Combined injuries with metaphyseal–diaphyseal
comminution (type V)
• Fractures complicated by nerve compression,
compartment syndrome, or multiple injuries
• Bilateral distal radius fractures
• An impaired contralateral extremity
TREATMENT

5. NONOPERATIVE
Technique of closed reduction (dorsally tilted fracture)
• The distal fragment is hyperextended.
• Traction is applied to reduce the distal to the proximal fragment with pressure applied to the distal radius.
• A well-molded long arm (“sugar-tong”) splint is applied, with the wrist in neutral to slight flexion. Studies
have demonstrated the ability of short arm splints to accomplish the same goal with improved patient
satisfaction.
• One must avoid extreme positions of the wrist and hand.
• The splint should leave the metacarpophalangeal joints free.
Once swelling has subsided, a well-molded cast is applied.
The cast should be worn for approximately 6 weeks or until radiographic evidence of union
has occurred.
The ideal forearm position, duration of immobilization, and need for a long arm cast remain
controversial;
Extreme wrist flexion should be avoided because it increases carpal canal pressure (and thus
median nerve compression

6. Reference
1. Campbell’s Operative Orthopaedics, 4-Volume Set 14th Edition
(2020)
2. Hoppenfeld Surgical Exposures in Orthopaedics: The Anatomic
Approach 5th Edition (2016)
3. Apley’s System of Orthopaedics and Fractures Ninth Edition, 2010