Question
A 57 year old woman falls backwards onto the dorsum of her flexed wrist.
- Describe the radiographs and classify the fracture.
- How does management differ from a dorsally displaced fracture?
- List early and late complications.
Answer
Description
- Extra-articular distal radius fracture with volar displacement and angulation of the distal fragment
- Smith fracture, Thomas type I
Thomas classification
| Type | Description |
|---|---|
| I | Extra-articular, volar angulation |
| II | Intra-articular oblique, volar displacement with the carpus (Barton like) |
| III | Extra-articular oblique, volar displacement |
Management
- Volar displacement is inherently unstable in a cast
- Closed reduction and an above elbow cast in supination can work for type I
- Most need volar locking plate fixation
- Flexor carpi radialis approach, plate acts as a buttress
- Assess DRUJ stability after fixation
Complications
- Median nerve injury and acute carpal tunnel syndrome
- Loss of reduction in a cast
- Malunion with reduced supination
- Flexor tendon irritation from a distally placed plate
- EPL rupture from prominent dorsal screws
- Complex regional pain syndrome
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.