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Two orthopaedic surgeons, who studied fractures of the distal end of the radius in the 19th century, “lend” their names to the most frequent fractures of the wrist. Abraham Colles described what we today call the Colles Fracture in 1814, and Robert William Smith described what we today call the Smith Fracture in 1847. Although both types of fractures describe the discontinuity of the largest out of the two bones of the forearm, the radius, at the point where it is articulated with the wrist (lower end), still, the injury mechanism is different.
The Colles-type fracture usually occurs after a fall onto the palm with the hand being stretched out. Its distinguishable feature is that the deformed end takes the shape of a fork (dorsal dislocation of the distal portion). Contrariwise, the Smith-type fracture usually occurs when the fall happens upon the palm while the wrist is bent inward (palmar dislocation of the distal portion).

Fractures of the lower end of the radius are the most frequent ones, and spread across all age groups: in younger patients, they are the result of high energy traumas (e.g., traffic accidents or falls from a great height), and, in patients over 45, they are the result of low impact injuries. In the second case, osteoporosis of a certain degree is observed, with the epidemiological data showing that the female population is more vulnerable.

Common symptoms include intense pain in the wrist, inability to move the radiocarpal joint, swelling, ecchymosis and deformity. Simple x-rays shall confirm the diagnosis. However, it is very important for a thorough clinical examination to be performed by an orthopaedist who is acutely aware of the physiology and anatomy of the wrist, since, apart from the fracture, concomitant injuries of the radicarpal and mesocarpal ligaments or the ligaments of the distal radioulnar joint may be observed. Therefore, wrist instability may develop, despite the fact that X-rays may appear normal.

Initially, the orthopaedist shall attempt to make a closed reduction of the fracture (reset to the normal position). Thereafter, the type of treatment option which shall be chosen (conservative or surgical) depends on the form, the dislocation and the degree of crush. The more stable a fracture is, the more likely it is to remain in place after plastering. Often, however, despite the plastering, the fractures are dislocated and a new reduction is required, so a radiographic follow-up examination is essential at about 10 days after the injury.
In most Colles fractures, the hand is immobilised for 30-40 days, while in the Smith-type fractures, it is immobilised for 5-6 weeks. However, in both cases, if an extensive dislocation, or even a crush of the bone are observed, an open reduction and an internal fixation are required. Thus, during the surgery, the radius is placed in its original position and held there with metal pins or plates and screws, or with an external metal frame, or with a combination of the above, depending on the type of fracture.
The advantages of surgical treatment are the immediate mobilisation of the radiocarpal joint and absolute stability at the site of injury, which allows for better healing and the liberty to use of the hand, a few days after surgery.
Regardless of the type of treatment, stiffness in the wrist is common to almost all patients, therefore, in the first phase of kinesiotherapy, the goal is to maintain the rotation and strength range of the wrist, the hand and the elbow. Most people are able to do light activities (e.g. swimming) within 1-2 months after the plaster has been removed, or after surgery. Full recovery for the practicing of vigorous activities should require 3-6 months after the injury.

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