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New Treatment for Wrist Fracture Shortens Recovery Time

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With 206 bones in the adult skeleton, it's not surprising that one or two of them might get broken over the course of a lifetime. As it turns out, the average American will experience at least one fracture at one time or another.

One of the bones most likely to be broken is the radius of the arm, an injury commonly known as a wrist fracture. Each year in the United States, approximately 300,000 people sustain a wrist fracture, usually as the result of falling.

Last year, Deborah McCoy was one of them. When she slipped and fell on her kitchen floor, she knew immediately that she had broken her wrist. What she didn't know was that the fracture was so severe that she would need surgery to fix it.

Fortunately, the majority of wrist fractures do not require surgical intervention. In most cases, a plaster cast is used to immobilize the joint for six to eight weeks while the bone is allowed to heal. Although wearing a cast may seem simple enough, it can cause a number of problems.

According to Joseph Slade, M.D., an orthopedic surgeon at Yale University School of Medicine, "When your wrist is in a cast for six or eight weeks, you can't turn your hand or close your fingers; and this is a severe disability. When the cast finally comes off, you can expect your hand to be very weak and stiff."

Many patients require several weeks of intensive physical therapy to strengthen the muscles of the affected wrist and hand. In some cases, patients may not recover normal wrist flexibility or function for several months to a year.

When casting alone isn't sufficient, as in Deborah McCoy's case, orthopedic surgeons typically recommend one of several surgical options. One of the most common procedures involves making a three- to five-inch incision in the skin over the fracture and attaching a metal plate to the outer surface of the fractured bone.

"The problem with using plates is that there's a risk they'll cause irritation to the surrounding tendons, muscles, or nerves," explained Slade. "Implanting this type of hardware also creates a large surgical wound and a lot of soft tissue swelling which delays recovery."

Unwilling to accept the potential complications of this type of surgery, Deborah was offered another relatively common treatment option: external fixation.

The procedure involves embedding metal pins into the bone on either side of the fracture.

The pins are then connected through the skin to an adjustable rod known as an external fixator, which remains outside the wrist. Since the device is cumbersome and a bit weighty, it tends to significantly limit the function of the affected hand.

"I just knew there had to be a better way," Deborah said. "I got on the Internet and did some research; and I found the Micronail."

Approved by the FDA in 2004, the Micronail is a small titanium rod designed to be implanted completely inside the fractured bone of the wrist. The surgery is minimally invasive, requiring only a three-quarter inch incision in the skin.

"The Micronail sits inside the bone, so there's very little risk of irritation to surrounding tendons, muscles, and nerves," Slade explained. "Because the surgery creates minimal soft tissue swelling, patients quickly regain their normal hand function."

In most cases, the surgery lasts less than an hour, and patients typically go home the same day, wearing a removable splint instead of a plaster cast. Afterwards, patients can expect to begin using the injured wrist in just one to two weeks.

"As soon as I came out of surgery, I could move my fingers and flex my wrist and hand, and the pain was virtually nonexistent," Deborah said. "For the next four weeks, I wore a splint that I took off twice a day to wash my hand and arm."

A month and a half after her surgery, Deborah's life had returned to normal.

"I was working and even lifting weights again with no problems, and I had 100 percent flexibility in my wrist," she said. "I can't tell that it was ever broken."

While the Micronail implant isn't appropriate for every patient, Slade said that it can be used in the treatment of a variety of wrist fractures.

"Other treatment methods still have a place in the management of wrist fractures, but the Micronail is a very valuable tool in the orthopedic surgeon's toolbox," he noted. "It helps patients get back to their normal lives as quickly as possible."

Rallie McAllister, M.D., M.P.H., is a family physician in Kingsport, Tenn., and author of "Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim." Her Web site is http://www.rallieonhealth.com. To find out more about Rallie McAllister, M.D., and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.

COPYRIGHT 2007 CREATORS SYNDICATE, INC.

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Comments

4 Comments | Post Comment
i broke the radius of my wrist in 4 places, had a closed reduction and had it put n a hard cast. x ray results good but specialist says better to have surgery and put in plate if i want to get full use of hand again. i live in bali so any surgery a scary thought. do u think micronail a better option or better to just let heal naturally in cast?
Comment: #1
Posted by: catherine Whitaker
Mon Oct 4, 2010 11:40 PM
ON OCT 21-2012 I WAS BUCKED OFF MY HORSE. BROKE MY WRIST IN 3 PLACES. DOCTOR SAID IT WOULD HEAL. THEY PUT IT IN A NEW TYP OF CAST THAT CAN BE TAKEN OFF AND PUT BACK ON BY MYSELF. IT WENT FROM ABOUT 3 INCHES UP MY ELBOW ALL THE WAY DOWN TO MY HAND. I TOOK IT OFF THE NEXT DAY AND CUT IT OFF WITH A HACK SAW TO WHERE IT WOULD JUST COVER ABOUT 10 INCHES OF THE ARM AND WRIST AND HAND. MY ARM HAD SWELLED SO BAD THAT I COULDN'T EVEN PUT IT BACK ON AFTER ABOUT 3 DAYS. SO I JUST STARTED ICEING IT TO KEEP THE SWELLOWING DOWN. I HAVE JUST STARTED USING IT TODAY WHICH IS THE NOVERBER 15 TO DRINK AND EAT WITH. I AM A 58 YEAR OLD MAN. SWELLING IS VERY LIGHT TO ALMOST NONE. I NEVER STOP MOVING MY FINGERS KNOW THAT THEY WOULD GET WEAK AND THE RECOVERY TIME WOULD BE LONGER.
Comment: #2
Posted by: tommy sanders
Thu Nov 15, 2012 11:05 PM
I m a boxing player....on feb 2-2013 i was fallen from a tree from 10 to 15 feets during my practice session and my wrist get a single fracture......some senior level doctors from AIIMS(all india institute of madical science) put my hand in a heavy cast and now they cut of my cast.....so tell me how can i heal my wrist more faster or stronger because i wanna continue my boxing again.
Comment: #3
Posted by: akshay kataria
Wed Mar 12, 2014 2:29 AM
I received a fracture at the distal end of the radius during playing tennis I fall down, now its three weeks its getting better but how much more time it will take pls gude me if poossible.
Syed Mustafa Ali
Comment: #4
Posted by: SMA
Wed Apr 9, 2014 11:27 PM
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