Hand iSAWE 18

Question

A 57 year old woman falls backwards onto the dorsum of her flexed wrist.

Hand iSAWE 18, lateral and PA radiographs of the wrist
Lateral and PA radiographs of the wrist. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 4.0.
  1. Describe the radiographs and classify the fracture.
  2. How does management differ from a dorsally displaced fracture?
  3. 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

TypeDescription
IExtra-articular, volar angulation
IIIntra-articular oblique, volar displacement with the carpus (Barton like)
IIIExtra-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.