We may recommend that your wrist fracture needs surgery to improve your outcome. This is a difficult decision to make and it takes years of training to recognise those injuries that will do badly in certain patients. We will discuss this with you at great length to enable you to make a decision about your care. We may also arrange a CT scan if the fracture is complex and requires surgery.
We would be more likely to offer surgery for the following reasons……….
- Displaced fractures that can’t be reduced without surgery
- Fractures that will predictably displace if left in a cast
- Fractures into the joint that are displaced
- Preference for earlier mobilisation (employment, carers, personal reasons)
There are a number of ways we treat these fractures with surgery……..
- Manipulation and wiring of the fracture
In these cases, we reduce the fracture and wire it. The wires are left out of the skin and a plaster cast applied. The wires are taken out around 5 or 6 weeks and then you can start physiotherapy.
- Open Reduction and Internal fixation with plates and screws
In these cases we have been unable to achieve a good reduction of the fracture or a strong fixation with wires. We need to perform open surgery through either the front or the back of the wrist or both if the fracture is very bad. If you have also broken the ulna bone we may need to make a third incision. You will be placed into a bulky bandage or a plaster slab for 1-2 weeks prior to physiotherapy.
Of course there are risks associated with surgery. They include
- Pain, stiffness, bleeding and infection
- Risk of tendon, nerve or arterial injury (very rare)
- Loss of position
- Long-term scar pain or hand/wrist pain
- Need for further surgery to remove metalwork
Most patients will return to reasonable function but it can take up to 18 months to achieve this. Very occasionally further surgery is needed to treat chronic ulnar sided wrist pain, carpal tunnel syndrome, post-traumatic arthritis, tendon rupture or where the fracture heals in the wrong position.