Smith's fracture

• Often described as a reverse Colles' fracture.

• AP and lateral views essential as may appear similar to Colles' fracture if an AP view alone is examined.

• Transverse fracture through the distal radius metaphysis with associated volar angulation and volar shift.

• Look for median nerve symptoms.

• Most Smith's fractures are treated with volar buttress plating and early mobilisation.

Barton's fracture

• The fracture line is intra-articular and runs obliquely as compared to the transverse fracture seen in Smith's type.

• Originally described as two types: dorsal and volar Barton's,

• Today the label of ‘Barton's fracture’ tends to be reserved for a fracture involving the volar distal radius with subluxation of the wrist and distal radio-ulnar joint.

• Tends to occur following high-velocity impact injuries.

• AP and lateral views required. Carpal displacement best seen on the lateral views.

• Treatment is with ORIF using volar buttress plating and early mobilisation.

Chauffeur's (Hutchinson) fracture

• Intra-articular fracture of the radial styloid.

• Usually secondary to a direct blow to the ulnar aspect of wrist.

• Best seen on the AP view.

• Treated with MUA and k-wire, percutaneous screw or ORIF.

Greenstick fracture

• Incomplete metaphyseal fractures seen as disruption of the cortex on one side with angualtion or bowing on the opposite.

• If angulated such that a clinical deformity exists this may require reduction and immobilisation; this depends on the child's age/remodelling potential and the surgeon's and parents' preferences. Most greenstick deformities will remodel but they take time and much parental anxiety can be avoided with a simple manipulation at the outset.

Physeal injuries – see Salter–Harris classification under peri-physeal injury

• Salter–Harris II injuries of the distal radius are the juvenile Colles' fracture.

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