2.  51 male working at
construction site when he
slipped and fell backwards,
breaking his call with his
outstretched arm behind
him, palm down. Pt states
with instant pain to right
wrist/forearm, with no
other injuries.
 T 98.3 P 88 BP 160/94 O2
99%
 Gen: Age appropriate male,
obvious pain, NAD
 MSK- Pt with swelling to
right wrist, obvious
deformity to ventral
surface but no laceration.
Radial pulse 1+ on right
 Neuro: pt with limited
extension/flexion at right
wrist secondary to pain; no
sensory abnormalities

4. Distal Radius Fx with volar angulation of distal fragment

5.  Pain control
 Closed reduction by reversing fx deformity w/
longitudinal traction
 Ortho consult, as many will require Operative
reduction/fixation
 If immediate consult not available, may place in long
arm splint with forearm supinated, wrist in neutral or
slightly extended, with follow up in next 48 hours

6.  Extra-articular palmarly displaced distal radius fx
 Volar angulation of fx is referred to as "Garden Spade"
deformity (reversed Colles Fracture)
 Mechanism:
- backward fall on the palm of an outstretched hand
causing pronation of upper extremity while the hand
is fixed to the ground
 Classification:
- Type I: extra articular;
- Type II: crosses into the dorsal articlar
surface;
- Type III: enters radiocarpal joint
- Volar Barton's Fracture = Smith's type III

8.  http://www.wheelessonline.com/ortho/smiths_fractur
e
 http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-
teaching/wrist/case62/case62background.html
 http://www.medcyclopaedia.com/library/radiology/ch
apter13/13_5/13_5_1.aspx
 http://www.netterimages.com/image/12833.htm
 https://www.imeducate.com/wp-
content/uploads/2010/04/Smith_AP_LAT.jpg