Wrist Case 5 History/Physical Exam

Smith Fracture

Smith fractures commonly result from a backward fall on the palm of an outstretched hand in supination that then shifts to pronation while the hand is fixed to the ground, or a fall backwards onto a hyperflexed hand.

The hand is displaced volarly and produces a "garden-spade deformity" on physical examination. A careful neurovascular examination should be performed, focusing especially on median nerve function as this is the most common nerve impairment seen with this fracture pattern.