What is this?
The bones of the forearm are called the radius and the ulna. At their lower end they join onto the eight small bones which make up the wrist joint. Because we instinctively put our hands out to save ourselves when we fall, and because the energy of the fall is often concentrated in this area, this may cause a fracture or break.
This fracture varies in its severity. In children the fracture is rarely serious and often consists of a small kink in the bone. These fractures sometimes need a manipulation (see below), but can often be treated by plaster cast or even a splint.
At the other end of the spectrum the fracture can run into the wrist joint, damaging the nice smooth surface. These fractures can be very difficult to treat.
What treatment is available?
The treatment of your fracture will vary considerably according to a number of factors including the strength of your bones, your age, the severity of the fracture and whether the fracture has stayed in alignment (undisplaced) or has moved (displaced).
1. Undisplaced fracture
Your surgeon may treat you in a plaster cast. Sometimes only a half cast will be used to begin with, especially of there is a lot of swelling. You may need regular Xrays to make sure that the fracture is staying in position. Sometimes fractures seem well lined up to begin with, but later move.
2. Displaced fracture
Your surgeon will use one of a number of methods of realigning your wrist. These are mostly performed under general anaesthetic; the anaesthetist will discuss this with you.
Your surgeon may simply push the bones back into correct alignment and put you arm in a plaster cast.
These are thin wires which can be drilled in the bone to hold the fragment together. These are sometimes left sticking through the skin and sometimes buried. They usually need to be removed (done in clinic).
Your surgeon will put a plate on your wrist, through a scar on the back or on the front, depending on the pattern of the fracture. The scar is usually 10cm (4in) long. With the modern generation of locking plates we can usually get away without plaster so that you can move your wrist immediately.
2.4 External fixation
Your surgeon may apply a frame to the outside of your arm, reaching form the forearm to the hand, and attached to pins in the bones. This is removed at a later date.
In any of the above cases you may need to have a bone graft taken from your hip to strengthen the bones in the wrist, although this is rare.
Your surgeon will discuss these options with you and suggest the most suitable in his opinion. Please understand that plans need sometimes to be changed mid operation if we find that our original choice of treatment is not working.
After the surgery you will usually be in a plaster cast, unless you have a plate applied.
What are the risks?
This surgery is normally safe and trouble free. There are however possible complications, both from the surgery and form the fracture itself. They include:
- Abnormal and prolonged pain response (CRPS)
- Nerve and tendon injury
After the surgery
You should keep you hand up as much as possible. Take regular painkillers for the first few days
You may need physiotherapy.
Any stitches will be taken out 7 to 14 days after surgery.
How long will I be off work?
Manual labour, usually eight to twelve weeks.
Clerical, six to eight weeks. If you can work in a plaster cast you may be able to go back after one or two weeks.
How long until I can drive?
On average two weeks after removal of the plaster.