Is Surgery Necessary for Wrist Fractures After a Month? Expert Insights

Wrist surgery

On April 2, the patient fell forward and injured their right hand.
X-rays showed fractures in the distal phalanx of the thumb, as well as in the ulnar and radial bones near the joint, with the radial head being particularly severe, showing a clear fissure approximately 4-5 mm wide and 5 cm long.
A cast was applied for immobilization.
One week later, during a follow-up visit, another X-ray was taken, and the doctor noted that there was no displacement.
Two days later, when seeing the orthopedic surgeon again, he recommended surgery, scheduled for 26 days after the injury.

Is it still appropriate to perform surgery after almost a month? Are there risks and potential complications associated with the surgery? I've heard about the possibility of infection and future pain due to weather changes; is this true? If there is osteoporosis, is surgery advisable? Would it be better to continue with the cast for immobilization? I would appreciate the doctor's valuable advice, thank you!

K.K., 60~69 year old female. Ask Date: 2017/04/16

Dr. Li Yongheng reply Orthopedics

If the fracture is displaced, surgery may be considered; however, if there is no significant displacement, it is recommended to continue with cast immobilization.
You may also seek a second opinion at another hospital.
Wishing you a speedy recovery.

Reply Date: 2017/04/16

More Info

When it comes to wrist fractures, particularly those involving the distal radius and other carpal bones, the decision to proceed with surgery after a month of conservative treatment can be complex. Based on the details you've provided, it seems that you have sustained multiple fractures, including a significant one in the radius, which is crucial for wrist stability and function.

Is Surgery Necessary After a Month?
1. Assessment of Fracture Stability: The first consideration is whether the fractures have remained stable. You mentioned that X-rays showed no displacement after the initial injury, which is a positive sign. If the fractures are stable and not causing significant pain or functional impairment, conservative treatment with a cast may still be appropriate. However, if there is any indication of instability or if the fractures are not healing properly, surgical intervention may be warranted.

2. Timing of Surgery: Waiting for nearly a month post-injury to consider surgery is not uncommon, especially if the fractures are stable. However, if the fractures are displaced or if there are concerns about non-union (failure to heal), surgery may be necessary sooner rather than later. The longer you wait, the more challenging the surgery may become if the bone begins to heal improperly.

Risks and Complications of Surgery
1. Surgical Risks: Like any surgical procedure, wrist surgery carries risks, including infection, nerve damage, and complications related to anesthesia. The risk of infection is particularly relevant given the nature of your injury and the fact that surgery is being considered after a significant delay.

2. Post-Surgical Complications: After surgery, patients may experience stiffness, pain, and swelling. Some individuals report increased sensitivity to weather changes, which can be attributed to nerve irritation or changes in the joint structure post-injury.
3. Long-term Outcomes: There is a possibility of developing arthritis in the wrist joint after a fracture, especially if the fracture involves the joint surface. This risk can be higher in cases of significant displacement or if the fracture is not treated appropriately.

Considerations for Osteoporosis
If you have osteoporosis, this can complicate both the healing process and the surgical approach. Osteoporotic bones are more fragile, which can lead to a higher risk of complications during surgery and a longer recovery time. It is essential to discuss your bone health with your physician, as they may recommend medications or supplements to improve bone density prior to surgery.

Continuing with Conservative Treatment
If your doctor believes that the fractures are stable and healing well, continuing with the cast may be advisable. Regular follow-ups with X-rays can help monitor the healing process. If you experience increased pain, swelling, or any signs of complications, you should seek immediate medical attention.

Conclusion
In summary, the decision to proceed with surgery for your wrist fractures after a month should be based on the stability of the fractures, your overall health, and the potential risks involved. It is crucial to have an open discussion with your orthopedic surgeon about your concerns, the necessity of surgery, and the potential outcomes. If you feel uncertain, seeking a second opinion from another orthopedic specialist can provide additional insights and help you make an informed decision.

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