Post-Surgery Concerns for Wrist Fracture Recovery: What to Expect

Post-operative issues related to the wrist?

Dear Dr.
Shi,
My mother fell at home in mid-February, resulting in a fracture and displacement of her left wrist joint.
Due to various reasons, her surgery was delayed until mid-May.
Because of the prolonged time since the injury, the bones in her wrist and hand have become misaligned and overlapped.
During the surgery, the excess bone was removed, and a titanium alloy plate was installed, along with bone grafting at the wrist.
I would like to ask:
1.
It has been four months since my mother's surgery, and follow-up X-rays show no issues with the bones; the injured area is gradually healing.
However, after each hand rehabilitation session, she experiences tightness and pain, especially at the site where the bone was removed, which is the most uncomfortable.
We consulted her attending physician, but he only prescribed painkillers without further explanation.
Is this a normal phenomenon? If so, what methods can help alleviate this discomfort?
2.
My mother's hand swelling has significantly reduced, but we recently noticed that the bones in her wrist appear thicker than before the injury.
Is this due to the titanium alloy plate, or is it a result of the bone healing process? (The attending physician mentioned that injured bones may grow thicker than they were originally, which has left us a bit confused.)
3.
My mother feels itching at the incision site on her palm (inside the wrist), but when she touches the incision area, her palm feels numb.
What could be causing this?
I apologize for the trouble, and I greatly appreciate your assistance.
Thank you very much.

Ping Ping, 20~29 year old female. Ask Date: 2019/09/27

Dr. Shi Guozheng reply Orthopedics

1.
It is inevitable for joints to become stiff after a fracture, and continuous rehabilitation is necessary for improvement.

2.
For a fracture to heal, a callus will form at the site, and with the presence of a plate, it may appear slightly thicker.

3.
If the surgical incision is on the palmar side, it may affect the nearby median nerve, leading to numbness.
Additionally, during the healing process, the wound releases histamines, which can cause itching sensations.

Reply Date: 2019/09/27

More Info

Post-surgery recovery from a wrist fracture can be a complex process, especially when the injury has been delayed in treatment. In your mother's case, it seems that she has undergone significant surgical intervention, including the removal of excess bone and the installation of a titanium alloy plate. Here are some insights regarding her recovery and the concerns you have raised:
1. Post-Operative Pain and Tightness: It is not uncommon for patients to experience tightness and pain in the wrist and hand after surgery, especially during rehabilitation. This discomfort can be attributed to several factors, including inflammation, scar tissue formation, and the body's natural healing response. The area where bone was removed may be particularly sensitive as it adjusts to the changes. To alleviate this discomfort, gentle stretching exercises, heat therapy, and physical therapy can be beneficial. It's essential to follow the guidance of a physical therapist who can tailor a rehabilitation program to your mother's specific needs. If the pain persists or worsens, it may be worth discussing with her doctor the possibility of adjusting her pain management plan or exploring other therapeutic options.

2. Bone Thickening: The observation that the wrist appears wider or thicker than before the injury can be attributed to a phenomenon known as "callus formation." After a fracture, the body often responds by creating new bone tissue to stabilize the area, which can lead to an increase in bone density and thickness. This is a normal part of the healing process. The presence of the titanium plate can also contribute to the perception of increased thickness, as it may create a more prominent contour under the skin. Over time, as healing progresses, the bone may remodel and return closer to its original shape, but it can also remain slightly thicker in some cases.

3. Nerve Sensations: The itching sensation in the palm and the numbness in the area around the incision site can be attributed to nerve regeneration and healing. During surgery, nerves may be stretched or irritated, leading to altered sensations post-operatively. Itching is often a sign of healing, while numbness can indicate that the nerves are still recovering. As the nerves heal, these sensations may change, and it's not uncommon for patients to experience a range of sensations, including tingling or "pins and needles." If the numbness persists or is accompanied by other concerning symptoms, such as weakness or increased pain, it would be advisable to consult with her physician for further evaluation.

In summary, while your mother's recovery may present challenges, many of the symptoms she is experiencing are typical for post-surgical rehabilitation. It is crucial to maintain open communication with her healthcare team, ensuring that any new or worsening symptoms are promptly addressed. Encouraging her to adhere to her rehabilitation program and to engage in gentle exercises can significantly aid in her recovery. With time and appropriate care, she should continue to see improvements in her wrist function and comfort.

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