Smith’s Fracture Physiotherapy & Rehab |Arunalaya Healthcare

Best Smiths-Fracture Treatment in Delhi

What is smiths-fracture?

A Smith’s fracture is a type of distal radius fracture, meaning a break in the radius bone (the larger of the two forearm bones) close to the wrist. What distinguishes a Smith’s fracture from other distal radius fractures (like a Colles’ fracture) is the direction of the displacement of the distal bone fragment.

In a Smith’s fracture, the broken end of the radius is displaced anteriorly (towards the palm or volar side of the wrist). This is often described as an “inverse dinner fork” deformity because the wrist appears to have a backward bend, opposite to the “dinner fork” deformity seen in Colles’ fractures.

Causes of Smith's Fracture

Smith’s fractures typically occur due to:
- Fall onto a Flexed Wrist: This is the most common mechanism. The person falls and lands on the back of their hand with their wrist flexed (bent inwards towards the forearm). The force pushes the distal radius fragment forward.
- Direct Blow to the Dorsal Aspect of the Wrist: A direct impact to the back of the wrist can also cause this type of fracture.
- Fall onto an Outstretched Hand with Pronation: While less common, sometimes a fall on an outstretched hand combined with pronation (turning the palm downwards) can lead to a Smith’s fracture.
- High-Energy Trauma: Car accidents, sports injuries, or other significant traumas can also cause Smith’s fractures, especially in younger, more active individuals.
- Osteoporosis: In older adults, particularly postmenopausal women, osteoporosis (weakened bones) significantly increases the risk of wrist fractures, including Smith’s fractures, even with low-energy falls.

Symptoms of Smith's Fracture

The symptoms are generally immediate and pronounced:
- Severe Wrist Pain: Localized to the wrist and forearm, especially on the thumb side.
- Swelling: Rapid swelling around the wrist, which can extend to the hand and forearm.
- Deformity (Inverse Dinner Fork Deformity): A visible and palpable abnormal angulation or bump on the palm side of the wrist, with the hand appearing displaced towards the palm. The wrist may look like it is bending backward.
- Tenderness: Significant tenderness when touching the wrist, particularly over the distal radius.
- Limited Range of Motion: Difficulty or inability to move the wrist and fingers due to pain and displacement.
- Bruising or Discoloration: Around the wrist, developing shortly after the injury
- Numbness or Tingling (less common but possible): If nerves (especially the median nerve, which runs through the carpal tunnel) are compressed or injured, there may be numbness, tingling, or weakness in the fingers. This needs immediate medical attention.

Advanced Physiotherapy for Smith's Fracture (Including Manual Therapy):-

Pain and Edema Management:-
- Cryotherapy: Regular application of ice packs to reduce pain and swelling.
- Elevation: Keeping the hand elevated above heart level.
- Gentle Compression: If allowed and not restricting circulation.
- Maintenance of Uninvolved Joints:
- Finger ROM: Encourage active, full range of motion exercises for the fingers (making a fist, straightening fingers, thumb opposition) to prevent stiffness and promote circulation.
- Elbow and Shoulder ROM: Regular active range of motion exercises for the elbow and shoulder to prevent stiffness in these joints.

Pain and Edema Control:
- Manual Edema Mobilization (MEM): Gentle lymphatic drainage techniques, retrograde massage.
- Contrast Baths (Warm and Cold): To improve circulation and reduce swelling and stiffness.
- Therapeutic Modalities: Ultrasound, low-level laser therapy (LLLT) may be used to aid tissue healing and reduce pain.
Restoration of Wrist Range of Motion (ROM) –
- Manual Therapy (Mobilization): This is crucial due to the prolonged immobilization and potential for significant stiffness, especially in the direction opposite to the original injury.
- Joint Mobilizations: Graded mobilizations to the radio-carpal joint (wrist joint) and mid-carpal joint to restore accessory movements (glides, rotations) that are necessary for full flexion, extension, and deviation.
- Posterior (dorsal) glides of the carpals on the radius to improve wrist flexion.
- Anterior (volar) glides of the carpals on the radius to improve wrist extension.
- Radial and ulnar glides to improve radial and ulnar deviation.
- Distal Radioulnar Joint (DRUJ) Mobilizations: Often stiff and painful after distal radius fractures. Mobilizations (anterior and posterior glides, rotation) are performed to improve forearm pronation and supination.
Soft Tissue Mobilization:
- Scar Tissue Mobilization: If surgery was performed, gentle but firm massage and friction techniques to surgical scars to prevent adhesions and improve tissue pliability.
- Forearm Musculature Release: Deep tissue massage, myofascial release, or instrument-assisted soft tissue mobilization (IASTM) for tight forearm flexors and extensors, which can restrict wrist movement.
- Active and Active-Assisted ROM Exercises: Progressing from gravity-assisted to full active movements in all planes (flexion, extension, radial/ulnar deviation, pronation, supination). Use of tools like dowel rods or a “therapy putty” can be helpful.
Progressive Strengthening:
- Isometric Exercises: Initial gentle muscle contractions without movement.
- Low-Resistance Isotonics: Gradually introduce resistance with light weights, resistance bands, or therapy putty.
- Wrist Flexor and Extensor Strengthening: (e.g., wrist curls, reverse wrist curls).
- Forearm Pronator and Supinator Strengthening: (e.g., using a hammer or screwdriver).
- Grip Strength: Squeezing a soft ball or putty.
- Finger and Thumb Strengthening: To improve overall hand function.
- Kinetic Chain Integration: Strengthening exercises for the entire upper limb (elbow, shoulder, scapular stabilizers) as their function impacts wrist mechanics.
Neuromuscular Control and Dexterity:
- Proprioception and Balance: Weight-bearing exercises through the hand (e.g., gentle weight shifts on all fours, progressing to planks) to improve joint position sense.
- Fine Motor Control and Dexterity Tasks: Gradually introduce tasks requiring precision (e.g., picking up small objects, buttoning clothes, manipulating coins, using tools, typing) to regain fine motor skills.
- Coordination Exercises: Activities that require coordinated wrist and finger movements.
Functional Rehabilitation and Return to Activity:
- Activity-Specific Training: Mimicking movements required for daily living, work, or sports.
- Ergonomic Assessment: Advising on modifications to workspaces or tools to prevent re-injury or strain.
- Sport-Specific Drills: For athletes, a gradual return to sport-specific activities, incorporating dynamic movements and impact drills as appropriate.

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