What You Should Know About Smith’s Fractures

wrist fracture
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The Smith’s fracture is a specific type of injury to the forearm bone (the radius) near the wrist joint. In this injury, there is displacement of the bone such that the wrist joint rests in front of its normal anatomic position. The traditional view is that this injury is most commonly caused by falling onto the back of the hand, but some research has pointed to falls on the palm of the hand being a common cause.

A Smith’s fracture is also sometimes referred to as a reverse Colles’ fracture. The Colles’ fracture is also a type of distal radius fracture, but the bone is pushed back rather than pushed forward.

Types of Wrist Fractures

The wrist joint is the junction of the forearm with the hand. The joint is formed by the two forearm bones (the radius and the ulna) joining together with the small bones of the wrist. Generally, when someone is describing a wrist fracture, they are talking about an injury to the end of the radius bone. However, the term wrist fracture can be used to describe other fractures such as scaphoid fractures, distal ulna fractures, and other bone injuries around the wrist joint.

Distal radius fractures can occur in many different types, and the specific type of fracture can help to determine the best treatment. There are a number of factors specific to the fracture that can influence decisions about ideal treatment; some of these factors include:

  • Fracture displacement (How far out of position are the bones?)
  • Fracture extension/joint involvement (Does the fracture enter the joint surface?)
  • Fracture stability (How likely are the bones to stay in position?)

In addition, there are a number of issues specific to patients that can influence the decision on how to best treat the specific fracture. Some of these considerations include:

  • Age of the patient
  • The activity level of the patient
  • Hand-dominance
  • Other medical issues (such as diabetes, tobacco use, malnutrition)


Because Smith’s fracture is quite unstable, this injury almost always needs surgical stabilization by some method. If the fracture is displaced from its normal position, it will generally need to be secured in position with metal implants, typically a plate and screws. Other options to stabilize the fracture include pins inserted through the skin and external fixation. Most patients prefer the plate and screws since the fracture is well secured, and they can begin early efforts to improve the mobility of the joint/

Also Known As: Wrist Fracture, Broken Wrist

5 Sources
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  1. Matsuura Y, Rokkaku T, Kuniyoshi K, et al. Smith’s fracture generally occurs after falling on the palm of the hand. J Orthop Res. 2017;35(11):2435-2441. doi:10.1002/jor.23556

  2. Porrino JA, Maloney E, Scherer K, Mulcahy H, Ha AS, Allan C. Fracture of the distal radius: epidemiology and premanagement radiographic characterization. AJR Am J Roentgenol. 2014;203(3):551-559. doi:10.2214/AJR.13.12140

  3. Ochen Y, Peek J, van der Velde D, et al. Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(4):e203497. doi:10.1001/jamanetworkopen.2020.3497

  4. Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Distal radius fractures in the elderly population. EFORT Open Reviews. 2020;5(6):361-370. doi:10.1302/2058-5241.5.190060

  5. Kamal RN, Shapiro LM. American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand clinical practice guideline summary management of distal radius fractures. J Am Acad Orthop Surg. 2022;30(4):e480-e486. doi:10.5435/JAAOS-D-21-00719

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.