Classic history and presentation: Patients will usually come to the ED with the classic story of FOOSH. This can be from tripping, riding a bike, or getting hit on the dorsum of the hand. Younger patients usually have high-energy mechanism of injury. Older patients or those with osteoporosis may present with a Smith fracture due to low-energy injury, such as a fall from a standing height or lower.
Prevalence: The distal radius is the most common fracture in the upper extremity with about 600 000 cases annually in the United States. Smith fractures make up about 5% of all radial and ulnar fractures combined. The highest incidence of Smith fractures is in young men and elderly women. For those aged 64-94, women are 6 times more likely to sustain a Smith fracture.
Risk factors:
- Older age
- Osteoporosis
- Female sex
Grade / classification system: Historically, Smith fractures were described as extra-articular only. In Smith's original description of his fracture, he stated that "the injury is a fracture of the lower end of the radius, with displacement of the lower fragment along with the carpus forwards, and the head of the ulna backwards." In 1957, F. Brian Thomas expanded the definition of the Smith fracture to the classification system below which includes a description very similar to that of the Barton fracture.
- Type 1: Extra-articular fracture only. Accounts for 85% of Smith fractures.
- Type 2: Intra-articular oblique fracture accounting for 13% of cases. Similar to the reverse Barton fracture.
- Type 3: Juxta-articular fracture accounting for less than 2% of cases.
