Wrist and Forearm Issues: Surgery, Healing, and Recovery

Wrist issues involving the radius and ulna?

Hello, doctor.
I am the inquirer from the previous issue 138823.
Today, I consulted another physician who mentioned that my radius is displaced by about 1mm, and the height difference between the radius and ulna at the wrist joint is less noticeable.
Since the fracture has been healing for 4 weeks and bone growth is evident, he does not recommend surgery unless I am very concerned.
He explained that surgery would involve breaking the newly healed bone and reattaching it, which would increase the wound and is unnecessary, especially since the fracture line on the radius joint surface has not completely healed.
I would like to ask the following questions:
1.
Is it reasonable not to recommend surgery?
2.
With a 1mm displacement of the radius and a relatively flat joint surface, will there be any long-term complications or loss of wrist function, and how severe could that be?
3.
Is it normal for the fracture to take 4 weeks with the radius joint surface fracture line not fully healed? Am I at risk for further displacement or nonunion at this stage?
4.
The physician mentioned that with the arm in a cast, I can lift a 600ml plastic bottle.
Would this not exacerbate the displacement?
5.
Should I keep my entire left hand completely still to prevent further displacement?
Thank you for your response.

Danxin de ren, 30~39 year old female. Ask Date: 2018/08/28

Dr. Shi Guozheng reply Orthopedics

1.
Reasonable
2.
Minimal impact
3.
This is considered normal; it may not dislocate again.

4.
No
5.
It is advisable to start exercising the joint earlier for better recovery.

Reply Date: 2018/08/28

More Info

Hello, thank you for reaching out with your questions regarding your wrist and forearm issues following your injury. Based on the information you've provided, it seems that you have experienced a fracture of the radius, which is a common injury. Let's address your questions one by one.

1. Is it reasonable not to recommend surgery?
Yes, it can be reasonable not to recommend surgery, especially if the displacement of the radius is minimal (1mm in your case) and the joint surfaces are relatively well-aligned. Surgical intervention is typically reserved for cases where there is significant displacement, instability, or when the fracture is not healing properly. If the doctor has assessed that the fracture is stable and healing well, opting for conservative management (like immobilization in a cast) can be a valid approach.

2. Will a 1mm displacement and a relatively flat joint surface lead to long-term issues?
A 1mm displacement is generally considered minor, especially if the joint surfaces are not significantly misaligned. However, there is always a risk of long-term complications such as stiffness, reduced range of motion, or arthritis, particularly if the joint surfaces were impacted during the injury. Regular follow-ups with your physician and physical therapy can help mitigate these risks and improve your functional outcomes.

3. Is it normal for the fracture to take four weeks to heal, and is there a risk of further displacement?
It is not uncommon for fractures to take several weeks to show significant healing, especially in the case of wrist fractures. Bone healing can vary widely among individuals based on factors like age, overall health, and the specific nature of the fracture. As for the risk of further displacement, it can depend on how well the fracture is stabilized and your activity level. If you are following your doctor's advice regarding immobilization, the risk should be minimized.

4. Could lifting a 600ml bottle with a cast worsen the displacement?
Lifting weights, even light ones, while in a cast can potentially stress the fracture site and lead to displacement, especially if the cast is not providing adequate support. It is essential to follow your doctor's recommendations regarding weight-bearing activities. If you have any doubts, it is best to err on the side of caution and avoid lifting until you have been cleared by your physician.

5. Should I keep my entire left hand completely still to prevent further displacement?
While immobilization is crucial in the early stages of healing, complete inactivity is not always necessary. Your doctor may recommend specific exercises or movements to maintain some range of motion in the fingers and wrist, which can help prevent stiffness. However, you should avoid any activities that could stress the fracture site. It's best to follow the guidance of your healthcare provider regarding how much movement is appropriate.

In summary, it seems that your current management plan is reasonable given the nature of your injury. Regular follow-ups and adherence to your doctor's advice will be essential for a successful recovery. If you have any concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for further evaluation. Remember, healing takes time, and patience is key in the recovery process.

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