Smith's, Barton's & Chauffeur's Fractures

Smith's Fracture — the 'reverse Colles''

A Smith's fracture is a fracture of the distal radius with volar (palmar/forward) displacement of the distal fragment — the exact opposite of a Colles' fracture, hence 'reverse Colles'. It results from a fall on the back of a flexed wrist (or a backward fall on the palm). It produces a 'garden-spade' deformity. Crucially, it is an unstable fracture that tends to redisplace in a cast, so although it can be reduced closed, it frequently requires operative fixation with a volar buttress (locking) plate.

Barton's and Chauffeur's Fractures

A BARTON'S fracture is an intra-articular fracture of the distal radius (the volar or dorsal rim) with subluxation or dislocation of the carpus along with the fragment — it is really a fracture-subluxation, is inherently unstable, and needs a buttress plate. A chauffeur'S (Hutchinson's) fracture is an intra-articular fracture of the radial styloid, often from a ligamentous avulsion.

How They Differ from Colles'

The distinction is essentially the direction of displacement and whether the joint is involved, which in turn determines stability and therefore treatment — the volar and intra-articular patterns are unstable and lean towards surgery, whereas the classic Colles' is often managed by reduction and a cast.

Direction of displacement of the distal fragment names the fracture.

• SMITH'S = distal radius fracture with volar displacement ('reverse Colles'), from a fall on the flexed wrist; 'garden-spade' deformity; unstable → usually volar plate.
• BARTON'S = intra-articular rim fracture of the distal radius with subluxation of the carpus (a fracture-subluxation) → buttress plate.
• Chauffeur'S (Hutchinson's) = intra-articular fracture of the radial styloid.
• Direction of displacement (dorsal vs volar) and joint involvement determine stability and treatment; Colles' (dorsal, extra-articular) is often cast, the others often need fixation.