## Smith Fracture: Mechanism and Injury Pattern **Key Point:** Smith fracture (reverse Colles) occurs from a **fall on outstretched hand (FOOSH) with the wrist in FLEXION**, causing volar displacement of the distal radial fragment. ### Mechanism of Injury | Feature | Colles Fracture | Smith Fracture | |---------|-----------------|----------------| | **Wrist position** | Extension + supination | **Flexion** + pronation | | **Distal fragment direction** | Dorsal | **Volar** | | **Classic deformity** | Dinner fork (dorsal) | Reverse dinner fork (volar) | | **Common cause** | Fall backward on extended wrist | Fall forward on flexed wrist | ### Clinical Context - **Smith fracture** = **"Barman's fracture"** (historically, from falls while serving drinks with flexed wrist) - More common in **elderly patients** with osteoporosis - Associated with **volar plate disruption** and potential **anterior interosseous nerve (AIN) injury** **High-Yield:** The mnemonic **"Smith = flexion"** helps distinguish it from Colles (extension). Both are distal radius fractures, but the wrist position at injury determines displacement direction. **Clinical Pearl:** Smith fractures have a higher risk of **median nerve compression** due to volar swelling and displacement. [cite:Rockwood & Green's Fractures in Adults Ch 8] 
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