Wrist Case 5 ED Management

Management of Smith fractures is similar to that of Colles fractures. However, the deforming forces of the wrist flexors lead to a higher percentage of subsequent operative intervention than Colles fractures, so early orthopedic consultation or prompt follow-up is essential. Prognostic factors that predict operative repair are:

• comminution
• significant radial shortening
• higher degrees of displacement

To reduce, start with a hematoma block, injecting approximately 10 mL of lidocaine into the fracture site dorsally. The arm is suspended in finger traps to distract the fracture fragments and dorsal pressure applied to the volar surface of the wrist to correct deformity. The patient is immobilized in a long-arm or sugar-tong splint with the wrist in neutral position and the forearm supinated. Post-reduction films should be viewed to evaluate the reduction. Follow up should be with a hand surgeon or general orthopedist within one week.