Smith kırığı

Özet

Smith kırığı, distal radius metafizinin volar tarafa açılanıp yer değiştirdiği ve Colles örüntüsünün ters yönünü taşıyan yaralanmadır; sıklıkla fleksiyondaki el üzerine düşme veya yüksek enerjili travma sonrası görülür. BT, kırık düzlemini, metafizer parçalanmayı ve radiokarpal yüzün gerçekten korunup korunmadığını çok düzlemli olarak gösterir. Distal fragmanla karpusun volar hareketi eşlik ediyorsa basit metafizer kırık tanımı yetersiz kalır. Eklem içi kenar kırığı veya karpal malhizalanma fark edilmezse yaralanmanın gerçek instabilite örüntüsü eksik raporlanır.

Faz ve pencere

Kontrastsız tanısal

Kontrast gerekmez. Distal radius metafizindeki kırık hattı, volar tilt/ötelenme, kortikal parçalanma ve radiokarpal eklem yüzünün devamlılığı değerlendirilir; karpal sıra ile distal fragmanın ilişkisi izlenir.

Kemik algoritması tanısal

Sagittal rekonstrüksiyon volar açılanma ve karpal hizayı; koronal ve aksiyel düzlemler radial-ulnar fragman ayrımını, sigmoid çentik uzanımını ve eklem yüzü parçalanmasını ortaya koyar.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

• Volar angulasyon — distal radius eklem yüzü palmar yöne döner ve dorsal tilt yerine volar tilt belirginleşir.
• Volar translasyon — distal fragman radius şaftına göre palmar tarafa kayar.
• Metafizer kırık hattı — kortikospongiyöz bileşkede oblik veya transvers hat distal parçayı şafttan ayırır.
• Volar metafizer parçalanma — distal fragmanın volar korteksi kesintili veya çok parçalı hale gelir.
• Eklem yüzü devamlılığı — klasik Smith örüntüsü eklem dışıdır; lunat ya da skafoid fossaya giren hat ek bileşen olarak tariflenir.
• Radiokarpal hizalanma — lunat ve skafoid distal radiusla birlikte volare taşınabilir; eklem ilişkisi sagittal düzlemde bozulur.
• Distal radioulnar eklem bileşeni — sigmoid çentik kırığı veya ulnar baş uyumsuzluğu eşlik edebilir.

Normalde

Normal sagittal bilekte distal radius eklem yüzü hafif volar eğimli, korteksi kesintisizdir ve lunat kemik bu yüzle uyumlu oturur. Lateral görüntüde distal radiusun volar-dorsal açılanması, eklem yüzü bütünlüğü ve karpal hizalanma değerlendirilir.

Ayırıcı tanı

Colles kırığı

distal fragman volar değil dorsal yönde açılanır veya ötelenir.

Volar Barton kırığı

volar eklem kenarı kırılır ve karpus kenar fragmanına eşlik ederek sublukse olur.

Volar lunat faset kırığı

volar-ulnar eklem kenarında küçük osteoligamentöz fragman ayrılır; karpal sıra fragmanla birlikte ilerleyebilir.

Distal radius impaksiyon kırığı

metafizer trabeküler ezilme vardır ancak belirgin volar translasyonlu ayrı distal fragman bulunmayabilir.

Tuzaklar

• Volar eğimli normal radius eklem yüzünü kırık açılanma sanmayın; şaft ekseniyle distal yüzün yönünü aynı sagittal rekonstrüksiyonda izleyin.
• Karpusun volar yer değiştirmesi tek başına Smith kırığının tanımı değildir; volar eklem kenarı fragmanı ve karpusun onunla birlikte hareketi Barton örüntüsünü düşündürür.
• Ön-arka planda eklem yüzü şüpheli görünüyorsa koronal ve sagittal rekonstrüksiyonlarda eklem hattını takip edin; eponim Smith kırığı klasik olarak eklem dışıdır.

Kendini dene

1. Metafizer distal radius kırığında distal parça volare açılanmış, eklem yüzü dışarıda. Hangi eponim en uygundur?

   • Smith kırığı
   • Colles kırığı
   • Volar Barton kırığı
   • Chauffeur kırığı
   Cevabı göster

   Smith kırığı. Volar açılanmış eklem dışı distal radius metafiz kırığı Smith örüntüsüdür. Colles dorsale açılanır; Barton eklem kenarını içerir; Chauffeur kırığı radial stiloiddedir.

2. Karpus volare sublukse ve volar eklem kenarı fragmanına oturuyor. Bu bulgu Smith kırığından çok hangi yaralanmayı destekler?

   • Volar Barton kırığı
   • Colles kırığı
   • Galeazzi kırıklı çıkığı
   • Ulnar stiloid kırığı
   Cevabı göster

   Volar Barton kırığı. Volar Barton kırığında volar eklem kenarı fragmanına karpus birlikte eşlik ederek sublukse olur. Colles dorsal metafizer örüntüdür; Galeazzi radius şaftı ve distal radioulnar eklemi kapsar; ulnar stiloid kırığı izole ulnar kemik çıkıntısındadır.

İlgili konular

• Colles kırığı
• Barton kırığı (dorsal/volar rim)
• Lunat faset impaksiyon kırığı (die-punch)

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 1 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Perioperative management of distal radius fracturespmc.ncbi.nlm.nih.gov
2. Fractures of Distal Radius: An Overviewpmc.ncbi.nlm.nih.gov
3. Multimodality Imaging in Wrist Fractures and Dislocationspmc.ncbi.nlm.nih.gov
4. Entrapment of the extensor pollicis longus tendon in a pediatric Smith fracture: A case report.pubmed.ncbi.nlm.nih.gov
5. [Not Available].pubmed.ncbi.nlm.nih.gov
6. High-energy injuries of the wrist.pubmed.ncbi.nlm.nih.gov
7. Adult scaphoid fracture.pubmed.ncbi.nlm.nih.gov
8. Distal radius malunion in adults.pubmed.ncbi.nlm.nih.gov
9. [Imaging in Kienböck's Disease].pubmed.ncbi.nlm.nih.gov
10. Wrist Trauma: More Than Bones.pubmed.ncbi.nlm.nih.gov
11. Ulnar tunnel syndrome: pathoanatomy, clinical features and management.pubmed.ncbi.nlm.nih.gov
12. [Three-dimensional planing and correction of osteotomies in the forearm and the hand].pubmed.ncbi.nlm.nih.gov
13. [Diagnostics and treatment of acute scaphoid fractures].pubmed.ncbi.nlm.nih.gov
14. Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures.pubmed.ncbi.nlm.nih.gov
15. Imaging for Acute and Chronic Scaphoid Fractures.pubmed.ncbi.nlm.nih.gov
16. Why do we use arthroscopy for distal radius fractures?pubmed.ncbi.nlm.nih.gov
17. Approach to Isolated Trapezoid Fractures.pubmed.ncbi.nlm.nih.gov
18. Emergency Medicine Management of Distal Radius and Ulna Fractures: Narrative Review.pubmed.ncbi.nlm.nih.gov
19. Low-Cost, Reusable Fracture Reduction Task Trainer for Distal Radius Fractures.pubmed.ncbi.nlm.nih.gov
20. Effect of closed reduction with external fixation versus open reduction and locking plate internal fixation on postoperative wrist function in elderly patients with distal radius fractures.pubmed.ncbi.nlm.nih.gov
21. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results.pubmed.ncbi.nlm.nih.gov
22. Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.pubmed.ncbi.nlm.nih.gov
23. Interventions for treating proximal humeral fractures in adults.pubmed.ncbi.nlm.nih.gov
24. Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2025: Transformative Trends in Healthcare.pubmed.ncbi.nlm.nih.gov
25. What's in a name? Upper extremity fracture eponyms (Part 1).pubmed.ncbi.nlm.nih.gov
26. Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2024: The Healthcare Evolution.pubmed.ncbi.nlm.nih.gov
27. The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty.pubmed.ncbi.nlm.nih.gov
28. Arthroscopic Direct Anterior-to-Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture.pubmed.ncbi.nlm.nih.gov
29. An analysis of different reconstruction techniques for the radius: a finite element analysis.pubmed.ncbi.nlm.nih.gov
30. Advances in Artificial Intelligence for Wrist Joint Injury Diagnosis.pubmed.ncbi.nlm.nih.gov
31. Impact of current and previous smoking on fracture risk in older women: the role of physical function, bone density, and bone microarchitecture.pubmed.ncbi.nlm.nih.gov
32. Arthroscopic Treatment of Scapholunate Instability: A Stage- and Ligament-Based Narrative Review.pubmed.ncbi.nlm.nih.gov
33. Cone beam CT in the imaging of musculoskeletal trauma: a scoping review.pubmed.ncbi.nlm.nih.gov
34. Radiation exposure for planning deformity corrections with hexapods: comparison of conventional X-ray, standard CT, and ultra-low-dose CT.pubmed.ncbi.nlm.nih.gov
35. The arrow and the target-description of the "Robin Hood" technique for fixation of tibial spine avulsion fractures: a technical note.pubmed.ncbi.nlm.nih.gov
36. Arthroscopic Latarjet using double suture-button fixation: learning curve, graft positioning, and complications - A two-center study of 80 patients.pubmed.ncbi.nlm.nih.gov
37. Development and Validation of Radiographic Measurement Templates for Standardized X-ray Analysis.pubmed.ncbi.nlm.nih.gov
38. Osteotomies: Indications, Imaging Appearance, Surgical Techniques, and Complications.pubmed.ncbi.nlm.nih.gov
39. Comparison of Short-Arm Immobilization and Long-Arm Immobilization in Conservatively Managed Distal Radius Fractures: A Meta-Analysis and Systematic Review.pubmed.ncbi.nlm.nih.gov
40. Challenges and complications of trans-osseous carpal tenodesis for scapholunate ligament tears.pubmed.ncbi.nlm.nih.gov
41. Computational models for predicting bone fracture healing: a review of modeling approaches, predictions, and emerging strategies.pubmed.ncbi.nlm.nih.gov
42. A Prospective Comparative Study Evaluating Functional Outcomes in Adolescents Undergoing Dynamic Compression Plating Versus Intramedullary Nailing for Both-Bone Diaphyseal Forearm Fractures.pubmed.ncbi.nlm.nih.gov
43. Management of periprosthetic fractures around cemented femoral stems: osteosynthesis and revision strategies.pubmed.ncbi.nlm.nih.gov
44. Outcomes of cemented and uncemented stem fixation in Vancouver B1 periprosthetic femur fractures treated with locking plates.pubmed.ncbi.nlm.nih.gov
45. Radiographic Analysis in Extra-Articular and Intra-Articular Distal Radius Fractures Treated with Variable-Angle Volar Locking Plate Fixation.pubmed.ncbi.nlm.nih.gov
46. Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?pubmed.ncbi.nlm.nih.gov
47. Ultrasound and shockwave therapy for acute fractures in adults.pubmed.ncbi.nlm.nih.gov
48. Combined Volar and Dorsal Approach for Fixation of Comminuted Intra-Articular Distal Radial Fractures.pubmed.ncbi.nlm.nih.gov
49. Adult distal radius fractures classification systems: essential clinical knowledge or abstract memory testing?pubmed.ncbi.nlm.nih.gov
50. The state of trial registrations in the field of Orthopaedics in years 2015-2020. A meta-epidemiological study.pubmed.ncbi.nlm.nih.gov
51. Arthroscopic Assisted Reduction and Percutaneous Fixation of Acute Perilunate Injuries.pubmed.ncbi.nlm.nih.gov
52. Fractures of the coronoid process: state of the art.pubmed.ncbi.nlm.nih.gov
53. Comparison of hand surgery certification exams in Europe and the United States using ChatGPT 4.0.pubmed.ncbi.nlm.nih.gov
54. Distal radius morphometry of volar curvature along with scaphoid and lunate facet inclinations and ulnar variance in the Anatolian population.pubmed.ncbi.nlm.nih.gov
55. Functional and Radiological Outcomes Following Volar Locking Plate Fixation for Distal Radius Fractures: A Prospective Analytical Study.pubmed.ncbi.nlm.nih.gov
56. Association of Radiological Parameters to Functional Outcomes after Distal Radius Fracture Fixation with Volar Locking Plate: A Prospective Cohort Study.pubmed.ncbi.nlm.nih.gov
57. Elastic intramedullary nailing for recurrent radial fracture associated with persistent ulnar bowing deformity in a pediatric patient: a case report.pubmed.ncbi.nlm.nih.gov
58. A Case of Nonanatomic Alignment: Acute Radial Head Dislocation Following Radial Shaft Osteosynthesis.pubmed.ncbi.nlm.nih.gov
59. Arthroscopic Treatment of Scaphoid Nonunion with Nonvascularized Autogenous Bone Grafting: A Prospective Study of 39 Patients.pubmed.ncbi.nlm.nih.gov
60. Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials.pubmed.ncbi.nlm.nih.gov
61. Interventions for treating wrist fractures in children.pubmed.ncbi.nlm.nih.gov
62. External fixation versus conservative treatment for distal radial fractures in adults.pubmed.ncbi.nlm.nih.gov
63. Proximal Row Carpectomy for Established Post-Traumatic Radiocarpal Arthritis Following Distal Radius Volar Rim and Scaphoid Fractures: A Case Report.pubmed.ncbi.nlm.nih.gov
64. ESTES recommendations regarding distal radius fractures.pubmed.ncbi.nlm.nih.gov
65. Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex.pubmed.ncbi.nlm.nih.gov
66. Design innovation and rationale of the intramedullary implants for treating Intertrochanteric fractures: A review.pubmed.ncbi.nlm.nih.gov
67. Minimally invasive sacroiliac joint fusion evidence gaps with biomechanics, devices, and industry influence: A narrative review.pubmed.ncbi.nlm.nih.gov
68. Uniplanar Coronal Tibiofemoral Subluxation in Patients After Multiligament Knee Injuries: A Multicenter Retrospective Case Series.pubmed.ncbi.nlm.nih.gov
69. Magnetic resonance imaging-based identification of the knee anterolateral ligament: A systematic review with meta-analysis.pubmed.ncbi.nlm.nih.gov
70. Tibial Eminence Avulsion Fracture Reduction With a Novel Adjustable-Loop Suture Repair Device: A Biomechanical Analysis.pubmed.ncbi.nlm.nih.gov
71. Clinical outcomes and complications of four surgical techniques for tibial avulsion fractures of the posterior cruciate ligament: a retrospective comparative study.pubmed.ncbi.nlm.nih.gov
72. Intra-osseous and coverage fixation for inferior pole fracture of the patella: a comparative finite element analysis and retrospective cohort study.pubmed.ncbi.nlm.nih.gov
73. Tibia plateau fracture mapping and its influence on fracture fixation.pubmed.ncbi.nlm.nih.gov
74. Cranial anatomy, palaeoneurology, palaeobiology and stratigraphic age of the large-bodied ornithopod, <i>Muttaburrasaurus langdoni</i> Bartholomai and Molnar, 1981, from the mid-Cretaceous of Australia.pubmed.ncbi.nlm.nih.gov
75. Ulnar-sided wrist pain. Part I: anatomy and physical examination.pubmed.ncbi.nlm.nih.gov
76. Treatment of distal radius fractures.pubmed.ncbi.nlm.nih.gov
77. Closed Reduction of Pediatric Distal Radial Fractures and Epiphyseal Separations.pubmed.ncbi.nlm.nih.gov
78. Percutaneous pinning for treating distal radial fractures in adults.pubmed.ncbi.nlm.nih.gov
79. Different methods of external fixation for treating distal radial fractures in adults.pubmed.ncbi.nlm.nih.gov
80. An Acta Orthopaedica educational article: Choosing treatment with an elderly patient having a distal radius fracture.pubmed.ncbi.nlm.nih.gov
81. Multimodality Imaging in Wrist Fractures and Dislocations.pubmed.ncbi.nlm.nih.gov
82. Risk of osteoporotic fractures in menopausal women with common mental health diagnoses prescribed SSRIs/SNRIs: cohort and self-controlled case series analyses.pubmed.ncbi.nlm.nih.gov
83. Paget's disease of bone with superimposed osseous metastasis from lung carcinoma: A case report.pubmed.ncbi.nlm.nih.gov
84. Posterior Lumbar Arthrodesis Using a Stand-Alone Hydrophilic Synthetic Bone Graft in the Setting of Postoperative Osteomyelitis/Discitis: A Case Report.pubmed.ncbi.nlm.nih.gov
85. Distal Radius Volar Shear Fractures: A Computed Tomography Characterization and Analysis.pubmed.ncbi.nlm.nih.gov
86. Beyond Palmer: a topographic classification of non-Palmer triangular fibrocartilage complex injuries.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.