Break your wrist this winter: Cast or Surgery?

[mtomaino]

This is a fitting question, and the answer has changed dramatically over the past few years for displaced fractures, in particular. In other words, if you are seen in an Emergency room and need to have your wrist "pulled on" to make it look better on an xray, then there is a very legitimate decision to make regarding whether to have surgery or to allow it to heal as is in a cast. Most importantly, close follow up is needed to ensure that if the position of your wrist changes after the reduction, it's picked up soon enough to allow correction. So make sure you are seen by a specialist the same week as your injury!
Why a cast?
Well--its simple and avoids surgery. As long as the wrist is reduced ans stable, and so long as you have good finger range of motion---this conservative approach is a good one.
Why surgery?
Well--because it ensures stability visa vis a rigid plate and screws that can hold the bone until it heals. This often obviates the need for a cast afterward, and facilitates recovery. Surgery is done as an outpatient, takes between 45 and 60 minutes, and can be performed under regional anesthesia with light sedation.

I recently recommended surgery on a woman in her late 70's after she fell in the 1000 islands---and not only was she healed by 6 weeks, but she was freed from a cast/ splint after 2 weeks, had very little pain after the first few days, and was delighted with her recovery.

So this season the take home message is to get follow-up for your wrist fracture with a hand specialist as soon as possible. Also---take 500 mg of Vitamin C daily for 2 months; this diminishes the risk that you may develop a postoperative pain syndrome which can lead to chronic pain and stiffness.

MMT