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Distal radius fractures displacements

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distal radius fracture Colles Smith Barton displacement types

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I now have enough material for a comprehensive answer. Here's a structured overview of distal radius fracture displacements:

Distal Radius Fracture Displacements

Normal Radiographic Anatomy ("11-22-11" Rule)

Before assessing displacement, know the baseline:
  • Radial height: 11 mm
  • Radial inclination: 22°
  • Volar tilt: 11°
Acceptable post-reduction parameters: radial shortening <3 mm, dorsal tilt <10°, intra-articular step-off <2 mm.
— Miller's Review of Orthopaedics, 9th Ed.

Eponymous Fracture-Displacement Patterns

1. Colles Fracture — Dorsal Displacement

  • Mechanism: Fall on an outstretched hand (FOOSH) — the most common pattern
  • Pattern: Transverse fracture of the distal radial metaphysis, extra-articular
  • Displacement: Distal fragment displaced and angulated dorsally (apex volar); produces the classic "dinner fork" deformity
  • Key: The carpus follows the displaced fragment
"A Colles fracture is a transverse fracture of the distal radial metaphysis, which is dorsally displaced and angulated." — Rosen's Emergency Medicine, 10th Ed.
Lateral X-ray — Colles fracture (dorsal displacement):
Colles fracture lateral X-ray showing dorsal displacement and angulation of the distal radial fragment

2. Smith Fracture ("Reverse Colles") — Volar Displacement

  • Mechanism: Fall on the dorsum of the hand, or direct blow to the dorsum
  • Pattern: Transverse metaphyseal fracture, usually extra-articular
  • Displacement: Distal fragment displaced and angulated volarly (apex dorsal); produces a "garden spade" deformity
  • Key: Opposite direction to Colles
"A Smith's fracture is a reverse Colles fracture, usually extra-articular and volarly displaced." — Schwartz's Principles of Surgery, 11th Ed.
Smith fracture X-ray (volar displacement, AP and lateral views):
Smith fracture X-rays: AP view (A) and lateral view (B) showing volar displacement of the distal radial fragment

3. Barton Fracture — Intra-articular Rim Fractures with Subluxation

  • Pattern: Intra-articular fracture; the fracture line exits through one cortical rim of the distal radius
  • Two subtypes:
    • Dorsal Barton: Fracture exits through the dorsal cortex → dorsal radiocarpal subluxation/dislocation
    • Volar (Reverse) Barton: Fracture exits through the volar cortex → volar radiocarpal subluxation/dislocation
  • Key feature: The carpus subluxates with the fracture fragment (distinguishes it from Colles/Smith)
"The Barton fracture refers to an intra-articular distal radius fracture extending through the dorsal cortex of the radius, often with dorsal subluxation or dislocation of the radiocarpal joint." — Rockwood and Green's Fractures in Adults, 10th Ed. (2025)

4. Chauffeur Fracture (Hutchinson Fracture) — Radial Styloid

  • Mechanism: Originally from engine backfire cranking; now from direct trauma or transmitted force via the scaphoid
  • Pattern: Isolated intra-articular fracture of the radial styloid
  • Displacement: Variable; may cause occult carpal (scapholunate) disruption
  • Key: Always assess for carpal ligament injury

Summary Comparison Table

FractureArticular InvolvementDirection of DisplacementCarpus
CollesExtra-articularDorsalFollows fragment
SmithUsually extra-articularVolarFollows fragment
Dorsal BartonIntra-articularDorsal rim + dorsal subluxSubluxates dorsally
Volar BartonIntra-articularVolar rim + volar subluxSubluxates volarly
ChauffeurIntra-articular (styloid)VariableRisk of SL injury

Treatment by Displacement Direction

DisplacementTreatment
MinimalNon-operative, cast immobilization
Dorsal (Colles)ORIF (volar locking plate) — now standard
Volar (Smith, volar Barton)ORIF with volar plate
Intra-articular step-off >2 mmSurgical fixation
"ORIF (volar) for volarly displaced fractures (Smith and volar Barton); also become standard for dorsally displaced fractures (Colles)." — Miller's Review of Orthopaedics, 9th Ed.

Associated Injuries to Rule Out

  • Scaphoid fracture
  • Scapholunate (SL) ligament injury
  • Ulnar styloid fracture / TFCC injury → risk of DRUJ instability
  • Acute carpal tunnel syndrome (median nerve dysfunction — most common complication overall)
  • EPL tendon rupture (attritional, near Lister's tubercle)
— Miller's Review of Orthopaedics, 9th Ed.; Rockwood and Green's, 10th Ed.
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