Distal Radius Fractures: Seeking the Right Treatment Options

Distal radius fracture

At the end of June, I accidentally fell and fractured my left radius.
I first went to a Far Eastern clinic for treatment, where I had an X-ray taken.
The doctor said that surgery was not necessary and that I only needed to use a splint for stabilization.
When I returned for a follow-up appointment a month later, my wrist and fingers were still swollen.
I asked the doctor about it, but he referred me to a large hospital for a consultation with a hand surgeon.
However, he still said that surgery was not required.
Later, at the consultation in Shuanghe, the doctor indeed recommended surgery and mentioned that if I did not have the surgery, my hand could become deformed and affect its function.
He also suggested using an out-of-pocket bone graft, which costs over 50,000 NTD.
When I inquired about whether health insurance would cover it, the doctor said that the materials covered by insurance were not good and would not significantly aid in recovery.
Who should I trust?

Lao Tou, 60~69 year old female. Ask Date: 2020/08/07

Dr. Zhan Xian reply Orthopedics

Hello, sir.
A distal radius fracture may experience further displacement during the healing process, so regular follow-up is necessary.
Whether surgery is needed and which type of plate and screws to use for fixation should be determined based on X-ray results.
Please consult with the orthopedic outpatient department.
Wishing you well!

Reply Date: 2020/08/07

More Info

When it comes to distal radius fractures, the treatment options can vary significantly based on the specifics of the fracture, including its type, location, and the degree of displacement. It sounds like you've had a challenging experience navigating your treatment options, and it's understandable to feel uncertain about which advice to follow.

From your description, it seems that you initially received conservative treatment, which is common for many distal radius fractures, especially if they are non-displaced or minimally displaced. The use of a splint or cast is often the first line of treatment, allowing the bone to heal naturally. However, if there is significant swelling or if the fracture is unstable, further evaluation is warranted.

The recommendation from your first doctor to see a hand surgeon is a prudent step. Hand surgeons specialize in upper extremity injuries and can provide a more detailed assessment of your fracture. If the swelling persists after a month, it may indicate that the fracture is not healing properly or that there are complications, such as malalignment or non-union.

The second opinion you received, which suggested surgical intervention, raises an important point. Surgery is often recommended for fractures that are displaced or at risk of leading to functional impairment or deformity. If the fracture is not properly aligned, it can lead to long-term issues, including loss of range of motion, chronic pain, and functional limitations in the wrist and hand.

Regarding the use of bone grafts or bone substitutes, such as the "骨丁" you mentioned, these materials can sometimes enhance healing, especially in cases where the fracture is complex or there is a risk of non-union. However, the cost and the effectiveness of these materials can vary. While some surgeons may advocate for their use, others may feel that traditional methods are sufficient, especially if the fracture is straightforward.

In terms of insurance coverage, it's essential to clarify with your healthcare provider and your insurance company about what is covered. While some materials may be deemed "better" by certain surgeons, insurance policies can differ widely in what they will reimburse. It’s worth discussing with your surgeon the rationale behind their recommendations and whether there are alternative options that might be more cost-effective while still ensuring a good outcome.

Ultimately, the decision on whether to proceed with surgery should be based on a thorough evaluation of your specific case, including the type of fracture, your overall health, and your personal goals for recovery. If you have doubts about the recommendations you’ve received, seeking a third opinion from another qualified orthopedic or hand surgeon could provide additional clarity and help you make an informed decision.

In summary, distal radius fractures can often be treated conservatively, but surgical intervention may be necessary in certain cases to prevent long-term complications. It’s crucial to weigh the advice of your healthcare providers, consider the potential risks and benefits of surgery, and ensure that you are comfortable with the treatment plan moving forward. Always advocate for your health and seek clarity on any recommendations that seem unclear or concerning.

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