Wrist Surgery - Pain, Fractures & Recovery
By Dr. Stuart Gold, M.D., Orthopedic Surgeon & Author
A person who has been referred to an orthopedic specialist because of a wrist injury may be wondering why a simple cast is not placed on their injured or fractured wrist. There are a number of concerns when a person has a wrist injury. One of the major concerns is the bones cannot be manipulated into the correct placement without doing so surgically in many cases. If the fracture extends to the joint of the wrist it is very important the bones are positioned in proper alignment to avoid painful problems in the future.
When Is Wrist Surgery Required?
Wrist surgery may be advised for a person who has suffered a fracture that cannot heal properly with a cast. A doctor will consider a number of factors before advising a patient for surgery. The severity of the break and the number of bones involved are often the determining factors. A doctor will consider the overall health of a patient as well before advising wrist surgery. The patient’s age and activity level is also considered before surgery is recommended.
Types Of Wrist Surgery
A doctor may perform surgery to set the bones with internally placed pins, screws or plates that hold the bones together during the healing process. Surgical wire may also be used to hold the bones in place. The plates are not generally used on the smaller bones. Biodegradable or metal screws are used to attach the plate to the bones involved. Titanium may also be used. In most cases, the internally placed pins, screws and plates are left in the body for good. The metals are designed to be durable and will not decay or rust.
A surgical procedure that involves holding the bones in place via externally placed pins may also be an option. An external fixator device is used to hold the bones in place during the healing process. The device may extend the length of the forearm or just a few inches. It consists of a metal bar that is attached to pins at each end and possibly in a couple of places along the length of the bar. The pins are placed in the bones that need stabilizing. The external fixation procedure can be a little intimidating, but it is not as painful as it may appear. Occasionally it is favored over the permanent placement of pins or screws internally. Once the bones have healed, usually after about six weeks, the fixator and pins are completely removed. The patient may need to wear a wrist brace for a couple of weeks following the fixation device removal.
The Recovery From Wrist Surgery
Depending on the location and the severity of the injury, it can take up to a year before a person’s wrist returns to normal. Typically, a person can begin using the wrist one to two months following surgery. There may be some stiffness or weakness in the injured wrist. Doctors may recommend physical therapy during the healing process to help strengthen the muscles around the fractured area. This can also help increase mobility of the joint.
Wrist surgery may also be necessary for other conditions like carpal tunnel, tendinitis or ligament damage. Carpal tunnel is a very common condition, and the symptoms are eased with wrist surgery, if non-operative treatment has failed. Inflamed tendons, which have not responded to rest, meds or injections have excellent results with releases. Ligament damage is frequently associated with a fracture.
However, it is possible to tear or damage the ligaments without actually breaking a bone. If an old fracture or ligament injury is causing extensive problems and is impossible to repair, a fusion may be necessary. This type of procedure is used in those who have arthritis or chronic pain in the wrist area. A fusion entails a surgeon removing the cartilage between the bones in the wrist to create one large bone. This procedure can reduce the pain, but a person will lose some mobility in the wrist. A fusion can involve just a few bones or the entire wrist.
Risks Of Wrist Surgery
As with any surgery there are some risks involved, but those are rare. Infection is always a concern when a person undergoes surgery. The benefits to having orthopedic wrist surgery in the majority of cases far outweigh the risks. Bones that do not heal correctly can cause arthritis to develop within a couple of years.
An improperly healed fracture can also dramatically reduce the functionality of the wrist. Younger people and athletes rely on a fully functioning wrist and cannot afford to risk either of the above-mentioned situations.