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New Treatment for Wrist Fracture Shortens Recovery Time
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 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.
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