Smith Fracture Classification
Smith fractures are classified into three types based on the Thomas classification, with types I and III typically managed conservatively when reduction is anatomic and stable, while type II and unstable type III fractures require internal fixation. 1
Classification System
Smith fractures (also known as reverse Colles fractures) are volar angulated distal radius fractures that can be categorized as follows:
Type I
- Simple transverse fracture with volar displacement of the distal fragment
- Conservative treatment is usually sufficient if reduction is anatomic and stable 1
Type II
- Oblique fracture line running from dorsal-distal to volar-proximal
- Requires internal fixation due to inherent instability 1, 2
- Volar buttressing technique with AO-T-plate is recommended 1
Type III
- Volar-displaced intra-articular fracture
- Conservative treatment is acceptable for stable fractures 1, 3
- Unstable fractures require internal fixation 1
Treatment Considerations
Conservative Management
- Appropriate for type I and stable type III fractures
- Requires anatomic reduction and stability 1
- Careful monitoring for displacement is essential
Surgical Management
- Indicated for all type II fractures and unstable type III fractures 1, 2
- Volar buttressing technique with plate fixation is the preferred approach 1
- Metal removal is advised after three months to prevent complications from bone overgrowth 2
Outcomes
- Functional outcomes after surgical treatment are generally good to excellent (77.2%) regardless of fracture type 3
- No significant correlation between anatomical result and functional outcome, though good anatomical results usually accompany good functional outcomes 3
- When comparing Smith fractures to Colles fractures (dorsal displacement), there is no significant difference in functional outcomes after surgical plate fixation 4
Clinical Pearls
- Careful radiographic assessment is crucial for proper classification and treatment planning
- For surgical cases, early intervention provides better outcomes
- Removal of hardware after three months prevents complications from bone overgrowth 2
- Regular follow-up with radiographic evaluation is essential to monitor healing and detect any displacement
The Thomas classification system for Smith fractures provides a practical framework for treatment decision-making, with the stability of the fracture being a key determinant in choosing between conservative and surgical approaches.