Smith's Fracture

1. Topic Overview

Summary

Smith's fracture is a distal radius fracture characterised by volar (palmar) displacement and angulation of the distal fragment — mechanistically and radiographically the opposite of the more common Colles' fracture. First described by Robert William Smith in Dublin in 1847, these fractures represent approximately 3-5% of all distal radius fractures. [1] The injury typically results from a fall onto a flexed wrist (reverse FOOSH mechanism) or a direct blow to the dorsum of the forearm, distinguishing it from the classic Colles' fracture which occurs with wrist extension.

Smith's fractures are inherently unstable due to the volar displacement combined with the deforming forces of the wrist flexor muscles. [2] The flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and finger flexor tendons all exert a volarly-directed force on the distal fragment, making closed reduction difficult to maintain. Conservative management with casting has historically demonstrated high failure rates of 30-50%, with frequent loss of reduction. [3] Consequently, operative fixation with a volar locking plate has become the gold standard treatment for displaced Smith's fractures in adults, providing stable fixation that permits early mobilisation and excellent functional outcomes. [4]

A critical clinical concern is acute carpal tunnel syndrome, which occurs in 5-15% of Smith's fractures due to the volar displacement directly compressing the median nerve within the carpal tunnel. [5] This represents an orthopaedic emergency requiring urgent decompression. Recognition of the volar displacement pattern on lateral radiographs and understanding that surgical fixation is typically required leads to optimal patient outcomes.

Key Facts

Clinical Pearls

"Garden Spade" vs "Dinner Fork": Smith's fracture creates a "garden spade" deformity with volar prominence of the wrist, while Colles' fracture creates the classic "dinner fork" deformity with dorsal displacement. Always examine the wrist from the lateral aspect to distinguish these patterns.

Median Nerve Alert: Acute carpal tunnel syndrome occurs more frequently with Smith's fractures than Colles' fractures due to the volar displacement directly impinging on the carpal tunnel. Always document median nerve function pre- and post-reduction. Persistent or worsening symptoms mandate urgent surgical decompression.

Casts Fail Frequently: Unlike Colles' fractures where casting remains a viable option for stable fractures, Smith's fractures are notoriously difficult to maintain in reduction with cast immobilisation alone. The volar displacement combined with flexor muscle forces makes conservative management unreliable. [3]

Volar Plate Advantage: The modified Henry approach for volar locking plate placement allows direct visualisation of the articular surface, anatomic reduction, and stable fixation permitting early mobilisation — all contributing to superior functional outcomes compared to conservative management. [6]

Why This Matters Clinically

Smith's fractures, though less common than Colles' fractures, have fundamentally different biomechanics and management implications. Their inherent instability means that attempted conservative treatment often fails, leading to malunion with persistent volar tilt. This affects wrist biomechanics, reduces grip strength, and may cause chronic pain. Recognition of the volar displacement pattern on the lateral radiograph, prompt identification of median nerve compression, and understanding that surgical fixation is typically indicated are essential for optimal patient outcomes.

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2. Epidemiology

Incidence & Prevalence

Smith's fractures account for approximately 3-5% of all distal radius fractures, making them significantly less common than Colles' fractures which represent 85-90% of distal radius fractures. [1,7] The overall incidence of distal radius fractures is approximately 195-258 per 100,000 person-years, with Smith's fractures therefore occurring at approximately 6-13 per 100,000 person-years. [8]

Demographics

The age distribution of Smith's fractures is bimodal, reflecting two distinct patient populations with different injury mechanisms:

Young Adults (20-40 years)

• Predominantly male
• High-energy trauma mechanism
• Motorcycle/bicycle handlebar injuries common
• Sports-related injuries
• Often involves dominant hand
• Typically good bone quality

Elderly Adults (> 60 years)

• Female predominance (osteoporotic population)
• Low-energy falls
• Fall onto flexed wrist
• Often involves non-dominant hand (protective reflex)
• Osteoporotic bone contributes to fracture pattern
• Higher complication rates

Risk Factors

Non-Modifiable Risk Factors

• Previous wrist fracture (2-4x increased risk)
• Advanced age (> 60 years)
• Female sex in osteoporotic age group
• Caucasian ethnicity
• Family history of osteoporotic fractures
• Early menopause

Modifiable Risk Factors

Geographic and Temporal Trends

Distal radius fracture incidence shows seasonal variation, with increased rates in winter months in temperate climates due to icy conditions. [11] The proportion of Smith's fractures relative to other distal radius fracture patterns has remained relatively stable over time, though the overall treatment approach has shifted substantially toward operative management with the advent of volar locking plate technology in the early 2000s. [4]

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3. Anatomy

Relevant Surgical Anatomy

Understanding the anatomy of the distal radius is essential for both comprehending the fracture pattern and performing safe surgical fixation.

Distal Radius Osteology

The distal radius has a complex three-dimensional shape that articulates with both the carpus and the ulna:

Normal Radiographic Parameters

Volar Soft Tissue Structures

The volar wrist contains critical structures that influence both fracture displacement and surgical approach:

• Pronator quadratus: Muscle overlying volar distal radius; elevated during surgical approach
• Flexor carpi radialis (FCR) tendon: Key landmark for Henry approach; lies radial to median nerve
• Median nerve: Enters carpal tunnel through Guyon's canal; at risk with volar displacement
• Flexor tendons: Pass through carpal tunnel; can be irritated by prominent hardware
• Radial artery: Lies radial to FCR; protected during approach
• Palmar cutaneous branch of median nerve: At risk during volar approach; travels in fascia between FCR and palmaris longus

Watershed Line Concept

The watershed line is a critical anatomical concept for volar plate positioning. [12] It represents the most volar prominence of the distal radius articular margin and defines the safe zone for plate placement. Plates positioned distal to this line risk flexor tendon irritation and rupture, particularly of the FPL tendon.

Carpal Tunnel Anatomy

The carpal tunnel is bounded:

• Roof: Transverse carpal ligament (flexor retinaculum)
• Floor and walls: Carpal bones
• Contents: Median nerve, 4 FDP tendons, 4 FDS tendons, FPL tendon

In Smith's fracture, volar displacement of the distal radius fragment directly narrows the carpal tunnel, predisposing to acute carpal tunnel syndrome. This is the primary mechanism for median nerve symptoms in this injury pattern. [5]

DRUJ Anatomy

The distal radioulnar joint (DRUJ) must be assessed in all distal radius fractures:

• Articulation: Sigmoid notch of radius with ulnar head
• Stabilisers: TFCC (primary), volar and dorsal radioulnar ligaments, pronator quadratus, ECU subsheath
• Clinical relevance: May be disrupted in Smith's fractures, especially with high-energy mechanism or significant displacement

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4. Pathophysiology

Mechanism of Injury

Smith's fractures occur through two primary mechanisms, both of which result in volarly-directed force transmission through the distal radius:

Mechanism 1: Fall on Flexed Wrist (FOFOW - "Reverse FOOSH")

This is the most common mechanism for Smith's fracture, mechanistically opposite to the Colles' fracture:

1. Patient falls with wrist in palmar flexion
2. Impact occurs on the dorsum of the hand
3. Axial load is applied with wrist flexed
4. Force vector drives distal radius fragment volarly
5. Result: Volar displacement with apex dorsal angulation

This mechanism is seen in:

• Falls while grasping objects
• Falls with clenched fist
• Falls from stairs with hand grasping rail
• Athletic injuries with wrist flexed at impact

Mechanism 2: Direct Dorsal Blow

A direct impact to the dorsal aspect of the forearm transmits force volarly:

1. Direct impact to dorsum of distal forearm
2. Force pushes distal fragment volarly relative to shaft
3. May occur with or without axial loading
4. Result: Volar displacement pattern

This mechanism is seen in:

• Motorcycle handlebar impacts
• Bicycle accidents
• Industrial injuries
• Assault with direct blow

Thomas Classification

The Thomas classification (1957) remains the standard for categorising Smith's fractures based on the fracture pattern: [13]

Exam Detail: Type I (Classic Smith's)

• Most common type (approximately 60-70%)
• Transverse fracture through distal radius metaphysis
• Volar angulation of distal fragment
• Extra-articular — joint surface intact
• Mechanism: Fall onto flexed wrist (low energy) or direct blow

Type II (Volar Barton's Variant)

• Intra-articular fracture
• Oblique fracture line extends into volar lip of radiocarpal joint
• Volar shear pattern
• Often associated with volar subluxation of carpus
• Most unstable type — requires operative fixation
• Higher risk of post-traumatic arthritis

Type III (Juxta-articular)

• Oblique fracture pattern
• More distal location than Type I
• Extra-articular but close to joint
• May propagate into joint with repeated manipulation

Fracture Instability

All Smith's fractures are considered inherently unstable due to multiple factors: [2,3]

Anatomical Factors

• Volar cortex is thinner and weaker than dorsal cortex
• Once fractured, no bony buttress prevents further displacement
• Volar periosteum disrupted

Muscular Forces

• FCR, FCU, and finger flexors all insert distal to fracture
• These muscles pull the distal fragment volarly
• Supination moment further destabilises the fracture
• Continuous deforming force during healing

Ligamentous Factors

• Volar carpal ligaments may remain attached to distal fragment
• Carpal mass follows distal fragment into volar displacement
• Creates "carpal subluxation" effect in Type II fractures

Instability Criteria

The following features predict failure of conservative management: [14]

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5. Clinical Presentation

History

Mechanism A detailed history of the injury mechanism helps distinguish Smith's from Colles' fracture:

Symptoms

Atypical Presentations

• Minimal displacement initially — may be mistaken for "sprain"
• Elderly with osteoporosis — may report minimal trauma
• Delayed presentation — attempted self-management
• Associated injuries in polytrauma — may be missed

Physical Examination

General Inspection

• Expose entire forearm and hand
• Compare to contralateral side
• Note position of comfort (usually guarded in mild flexion)
• Assess for open wounds (open fracture)

Specific Findings

Neurovascular Assessment (MANDATORY)

DRUJ Assessment

• Piano key test: Stabilise radius, depress ulnar head
• Compare to contralateral side
• Pain or excessive movement suggests DRUJ injury

Red Flags

[!CAUTION] Red Flags Requiring Urgent Action:

Neurological

• Numbness in median nerve distribution (thumb, index, middle fingers)
• Weakness of thumb abduction/opposition
• Progressive paraesthesia
• Two-point discrimination > 6mm

Vascular

• Absent or weak radial pulse
• Delayed capillary refill (> 2 seconds)
• Pale, cool fingers
• Pain on passive finger extension

Soft Tissue

• Open wound communicating with fracture
• Tense forearm compartments
• Pain out of proportion to injury
• Pain on passive finger extension (compartment syndrome)

Fracture

• Gross instability with subluxation
• Severe deformity with skin tenting

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6. Differential Diagnosis

Primary Differentials

Distinguishing Smith's from Colles' Fracture

Must Not Miss

1. Open fracture: Look carefully for small wounds — may be puncture from bone spike
2. Acute carpal tunnel syndrome: Document median nerve status pre- and post-intervention
3. Vascular injury: Rare but requires immediate intervention
4. Associated carpal injuries: Scaphoid, scapholunate ligament

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7. Investigations

Bedside Assessment

Mandatory Initial Assessment

• Complete neurovascular examination (document pre-intervention)
• Skin integrity assessment
• Compartment assessment (forearm tenderness, pain on passive stretch)
• Assessment for associated injuries

Imaging

First-Line Imaging

Radiographic Analysis (Lateral View — Most Important)

The lateral radiograph is critical for distinguishing Smith's from Colles' fracture:

Radiographic Analysis (PA View)

Second-Line Imaging

Laboratory Tests

Routine laboratory investigations are not required for diagnosis but may be indicated in specific circumstances:

Diagnostic Criteria

Smith's fracture is diagnosed when ALL of the following are present:

1. Clinical history consistent with mechanism (fall on flexed wrist or direct dorsal blow)
2. Physical examination showing volar wrist prominence
3. Lateral radiograph demonstrating volar displacement/angulation of distal radius fragment

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8. Management

Overview of Management Strategy

Smith's fractures differ from Colles' fractures in their inherent instability. The management algorithm therefore prioritises early identification of fracture pattern, assessment for complications (particularly median nerve compression), and recognition that most displaced fractures require operative fixation.

Emergency Department Management

Initial Assessment and Stabilisation

1. Analgesia: IV morphine/fentanyl for adequate pain control
2. Neurovascular documentation: Formal documentation BEFORE any manipulation
3. Radiographs: PA and lateral wrist
4. Temporary immobilisation: Backslab in neutral position
5. Elevation: Reduce swelling
6. Ice: Wrapped application for 20 minutes

Closed Reduction (If Indicated)

Closed reduction may be attempted in the ED for significantly displaced fractures, primarily to:

• Relieve median nerve compression
• Reduce skin tension
• Provide temporary stabilisation pending definitive management

Reduction Technique for Smith's Fracture

1. Adequate analgesia (haematoma block, Bier's block, or procedural sedation)
2. Apply traction in the line of the forearm
3. Supinate the forearm (opposite to Colles' where you pronate)
4. Extend the wrist (opposite to Colles' where you flex)
5. Apply dorsal pressure to the distal fragment
6. Maintain position and apply above-elbow backslab with forearm supinated, wrist in slight extension

Post-Reduction Care

• Repeat neurovascular examination
• Check radiographs to assess reduction
• Elevation
• Clear analgesia instructions
• Urgent orthopaedic review

Conservative Management

Indications (Limited)

Conservative management is appropriate ONLY for:

• Truly minimally displaced fractures (rare)
• Patients unfit for surgery (significant comorbidities)
• Patient preference after informed discussion of high failure rate

Technique

Monitoring (CRITICAL)

[!WARNING] High Failure Rate: Conservative management of Smith's fractures has a 30-50% rate of loss of reduction requiring conversion to surgery. [3] Weekly radiographic follow-up is mandatory for the first 3 weeks.

Surgical Management

Indications (Most Smith's Fractures)

Timing

Surgical Techniques

Volar Locking Plate ORIF (Gold Standard) [4,6]

This is the standard operative treatment for Smith's fractures in adults.

Exam Detail: Surgical Steps for Volar Plate Fixation

1. Positioning: Supine, arm on hand table, tourniquet applied
2. Incision: FCR approach, 6-8 cm longitudinal incision
3. Superficial dissection: Incise FCR sheath, retract FCR ulnarly
4. Deep dissection: Incise fascia between FCR and radial artery
5. Protect structures: Radial artery (radial), median nerve (ulnar)
6. Pronator quadratus: Incise radially, elevate as L-shaped flap
7. Fracture exposure: Visualise volar cortex and fracture site
8. Reduction: Traction, manipulation, restoration of volar tilt and radial length
9. Provisional fixation: K-wires if needed
10. Plate application: Contoured volar locking plate, position proximal to watershed line
11. Fixation sequence: Proximal cortical screw first (gliding hole), then distal locking screws
12. Check reduction: Fluoroscopy — PA, lateral, and oblique views
13. Articular screws: Confirm subchondral position, not penetrating dorsal cortex
14. Closure: Repair pronator quadratus, skin closure

Intraoperative Fluoroscopy Checks

Alternative Fixation Methods

Carpal Tunnel Release

DRUJ Assessment and Management

Post-operative Care

Immediate Post-operative

Rehabilitation Protocol

Follow-up Schedule

Special Populations

Elderly Patients (> 65 years)

High-Demand Patients (Athletes, Manual Workers)

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9. Complications

Immediate Complications (Hours-Days)

Early Complications (Weeks)

Late Complications (Months-Years)

Flexor Pollicis Longus Rupture

FPL rupture is a specific complication of volar plate fixation that deserves particular attention: [16]

Risk Factors

• Plate positioned distal to watershed line
• Prominent distal screws
• Inadequate pronator quadratus repair
• Malpositioned plate

Prevention

• Careful plate positioning (proximal to watershed line)
• Confirm screw length on lateral fluoroscopy
• Consider low-profile plates
• Repair pronator quadratus when possible

Management

• Hardware removal
• Tendon reconstruction (may require staged procedure)
• Transfer or grafting

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10. Prognosis & Outcomes

Natural History

Without treatment, Smith's fractures would heal with malunion in volar angulation. This malunion affects:

• Wrist biomechanics (altered load transfer)
• Grip strength (reduced by 20-40%)
• Forearm rotation (limited pronation/supination)
• Pain (chronic, activity-related)
• Appearance (visible deformity)

Outcomes with Treatment

Volar Locking Plate ORIF [4,6,17]

Conservative Management [3]

Prognostic Factors

Favourable Factors

• Young age
• Extra-articular fracture (Type I)
• Anatomic reduction achieved
• Early mobilisation post-surgery
• Good bone quality
• Compliant with rehabilitation
• No associated ligamentous injury

Unfavourable Factors

• Intra-articular involvement (Type II)
• Significant comminution
• Associated DRUJ injury
• Osteoporotic bone
• Late presentation
• Delayed treatment
• Poor compliance
• CRPS development
• Workman's compensation claim [18]

Return to Activity

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11. Evidence & Guidelines

Key Guidelines

BOAST 12: The Management of Distal Radius Fractures (BOA, 2017) [19]

Key recommendations:

• Operative fixation recommended for unstable fractures
• Volar locking plates preferred for volar displacement patterns
• Early mobilisation following stable internal fixation
• Assessment for osteoporosis in low-energy fractures in patients > 50 years

NICE NG38 and NG177: Fractures (Non-complex)

• Supports early mobilisation
• Appropriate surgical intervention for displaced/unstable fractures
• Falls prevention programmes for elderly

AAOS Clinical Practice Guideline: Distal Radius Fractures (2021)

• Moderate evidence supporting operative fixation for displaced, unstable fractures
• Volar locking plates demonstrate comparable outcomes to other fixation methods

Landmark Trials

DRAFFT Trial (Costa et al., 2014) [20]

DRAFFT-2 Trial (Costa et al., 2022)

Evidence Summary

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12. Examination-Focused Content

Common Exam Questions

FRCS Orth Viva Questions

1. "Describe the classification of Smith's fractures and how this influences management."
2. "What is the mechanism of injury in Smith's fracture and how does it differ from Colles' fracture?"
3. "How would you manage a 55-year-old with a displaced Smith's fracture and median nerve symptoms?"
4. "Describe your surgical approach for volar plating of a distal radius fracture."
5. "What complications are specific to volar plate fixation?"
6. "How do you position the volar plate and why is this important?"

Viva Points

Viva Point: Opening Statement

"Smith's fracture is a distal radius fracture characterised by volar displacement and angulation, representing the mechanical opposite of Colles' fracture. It was first described by Robert William Smith in Dublin in 1847 and accounts for 3-5% of distal radius fractures. The injury typically results from a fall onto a flexed wrist or direct dorsal blow and is classified using the Thomas classification into three types based on fracture pattern."

Key Facts to Mention

• Thomas classification: Type I (extra-articular transverse), Type II (intra-articular volar Barton), Type III (juxta-articular oblique)
• Inherently unstable due to volar displacement and deforming forces of wrist flexors
• Conservative management has 30-50% failure rate
• Volar locking plate is gold standard for displaced fractures
• Acute carpal tunnel syndrome in 5-15% — requires urgent decompression
• Watershed line concept important for plate positioning to avoid FPL rupture

Evidence to Quote

• DRAFFT trial: K-wire vs plate for dorsally displaced DRF
• BOA BOAST 12 guidelines
• High redisplacement rate with conservative management (30-50%)

Model Answer

Q: "A 45-year-old motorcyclist presents following a fall with wrist pain. X-ray shows a volarly displaced distal radius fracture. How would you manage this patient?"

A: "This sounds like a Smith's fracture, a distal radius fracture with volar displacement, likely sustained from handlebar impact.

My initial assessment would include a thorough history of the mechanism, assessment of handedness and occupation, and any relevant comorbidities.

On examination, I would look for the classic 'garden spade' deformity with volar prominence. I would perform a comprehensive neurovascular examination, specifically documenting median nerve function — motor power of APB and sensory testing of the radial three and a half digits — as acute carpal tunnel syndrome occurs in 5-15% of Smith's fractures. I would assess for open wounds and compartment syndrome.

I would request PA and lateral radiographs of the wrist. On the lateral view, I would expect to see volar angulation and displacement of the distal fragment. I would classify this according to the Thomas classification — Type I if extra-articular, Type II if there is volar lip involvement, or Type III if an oblique juxta-articular pattern.

If there is significant displacement, I would perform closed reduction with analgesia using traction, supination, wrist extension, and dorsal pressure on the distal fragment, then apply an above-elbow backslab. I would repeat the neurovascular examination and obtain post-reduction films.

Definitive management for a displaced Smith's fracture in this healthy working-age patient would be operative fixation with a volar locking plate through the modified Henry approach. This provides stable fixation, allows early mobilisation, and has excellent outcomes with 85-95% achieving good to excellent functional results.

Post-operatively, I would commence early finger range of motion exercises and begin wrist mobilisation at 2 weeks. I would counsel the patient regarding return to work at 6-12 weeks for office duties or 12-16 weeks for manual work.

If there were any median nerve symptoms, I would treat this as urgent and ensure carpal tunnel decompression was performed at the time of surgery through extension of the volar approach."

Common Mistakes in Exams

What Fails Candidates

• Confusing Smith's and Colles' fracture mechanisms and deformities
• Not mentioning median nerve assessment as a priority
• Recommending conservative management for a displaced Smith's fracture
• Not knowing the Thomas classification
• Failing to describe the reduction manoeuvre correctly (should be supination and extension, opposite to Colles')
• Not mentioning the watershed line when discussing volar plate positioning
• Not recognising that Smith's fractures are inherently unstable

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13. Patient/Layperson Explanation

What is a Smith's Fracture?

A Smith's fracture is a break in the main bone of your forearm (the radius) near the wrist. Unlike the more common type of wrist fracture where the bone tilts backward, in a Smith's fracture the broken end tilts toward your palm. It's sometimes called a "reverse Colles' fracture."

How does it happen?

This type of break usually happens in one of two ways:

1. Falling onto a bent wrist — if you fall and land with your wrist curled under
2. A direct blow — such as hitting your wrist on motorcycle handlebars during an accident

Why is surgery usually needed?

The muscles in your forearm that bend your wrist are very strong. These muscles attach to the broken piece of bone and keep pulling it out of position. This makes it very difficult to keep the bone in place with just a cast. Studies show that casts fail to hold the bone in the right position in about one-third to one-half of cases.

Surgery involves putting a small metal plate and screws on the inside of your wrist bone to hold it in place while it heals. This is a very common and successful operation.

What are the risks?

The main concern with Smith's fracture is pressure on a nerve that runs through your wrist (the median nerve). If the broken bone presses on this nerve, you may feel numbness or tingling in your thumb, index, and middle fingers. If this happens, you need treatment quickly to release the pressure on the nerve.

What to expect after surgery

• Hospital stay: Usually same-day or overnight
• Wrist support: You may have a splint for the first week or two
• Finger exercises: Start immediately to prevent stiffness
• Wrist exercises: Begin at 2 weeks
• Suture removal: At 2 weeks
• Return to office work: 2-4 weeks
• Return to driving: 4-8 weeks (when comfortable)
• Return to manual work: 12-16 weeks
• Full recovery: 3-6 months

When to seek urgent help

Contact your doctor or go to A&E if you notice:

• Numbness or tingling in your thumb, index, or middle fingers
• Fingers becoming pale, cold, or blue
• Increasing pain despite painkillers
• Significant swelling not improving with elevation
• Wound problems — redness, discharge, or opening

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14. References

Primary Sources

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8. Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. doi:10.1186/1471-2474-8-48 PMID: 17540030

9. Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017;18(1):240. doi:10.1186/s12891-017-1596-z PMID: 28578694

10. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am. 2011;93(4):348-356. doi:10.2106/JBJS.J.00303 PMID: 21239661

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15. Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am. 1997;22(5):792-800. doi:10.1016/S0363-5023(97)80071-8 PMID: 9330135

16. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21(5):316-322. doi:10.1097/BOT.0b013e318059b993 PMID: 17485996

17. Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. J Bone Joint Surg Am. 2009;91(1):55-65. doi:10.2106/JBJS.G.01498 PMID: 19122079

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19. British Orthopaedic Association. BOAST 12: The Management of Distal Radial Fractures. 2017. Available at: https://www.boa.ac.uk/standards-guidance/boast.html

20. Costa ML, Achten J, Parsons NR, et al. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ. 2014;349:g4807. doi:10.1136/bmj.g4807 PMID: 25096595

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15. Summary Box

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Medical Disclaimer: MedVellum content is for educational purposes and clinical reference. Clinical decisions should account for individual patient circumstances. Always consult appropriate guidelines and specialists for patient care.