A 62-year-old woman with osteoporosis presents with a wrist fracture after a fall on outstretched hand. Radiographs show volar angulation and volar displacement of the distal radius fragment. Regarding the management and complications of this fracture, all of the following are correct EXCEPT:

Explanation

## Clinical Case: Smith Fracture (Reverse Colles) **Key Point:** The clinical presentation describes a **Smith fracture** — volar angulation and volar displacement of the distal radius. The question asks which statement is NOT correct. ### Distinguishing Colles from Smith Fracture ```mermaid flowchart TD A[Distal Radius Fracture]:::outcome --> B{Direction of angulation?}:::decision B -->|Dorsal angulation| C[Colles Fracture]:::outcome B -->|Volar angulation| D[Smith Fracture]:::outcome C --> E[FOOSH in elderly]:::outcome D --> F[FOOSH in younger or direct blow]:::outcome C --> G["Dinner fork" deformity]:::outcome D --> H["Reverse dinner fork" deformity]:::outcome E --> I[Dorsal plating or closed reduction]:::action F --> J[Volar plating preferred]:::action ``` ### Colles vs Smith: Key Differences | Feature | Colles | Smith | |---------|--------|-------| | **Angulation** | Dorsal | Volar | | **Displacement** | Dorsal | Volar | | **Radial deviation** | Yes | No | | **Mechanism** | FOOSH in elderly | FOOSH in younger or direct blow | | **Appearance** | "Dinner fork" | "Reverse dinner fork" | | **Preferred fixation** | Dorsal plating or closed reduction | Volar plating (Henry approach) | **High-Yield:** In the case presented, the deformity is **volar angulation** (Smith fracture), NOT dorsal angulation. Therefore, option 4 is incorrect. ### Management of Smith Fracture 1. **Volar plating** — Preferred method; provides direct visualization and anatomic reduction 2. **Volar Henry approach** — Standard surgical approach for volar plating 3. **Closed reduction** — May be attempted in simple fractures but often inadequate 4. **Dorsal plating** — Less commonly used for Smith fractures; reserved for specific patterns **Clinical Pearl:** Smith fractures have a higher risk of: - Volar soft tissue injury (flexor tendons, median nerve) - Anterior interosseous nerve (AIN) injury - Carpal tunnel syndrome - Loss of reduction with closed treatment alone ### Complications Common to Both Colles and Smith 1. **EPL rupture** — Late complication (weeks to months), more common in Colles but can occur in Smith 2. **Loss of radial height** — Leads to post-traumatic arthritis and grip strength loss 3. **Malunion** — Results in functional impairment 4. **Stiffness** — If immobilization is prolonged **Warning:** Do not confuse the primary deformity. Colles = dorsal; Smith = volar. This is tested frequently in NEET PG. [cite:Rockwood & Green's Fractures in Adults Ch 18]