Recovery from Car Accident Fractures: Key Questions Answered

Fractures from a car accident?

Hello, doctor.
I was in a car accident on May 12, which resulted in a fracture of the right ulnar styloid, a partial dislocation of the distal radioulnar joint (DRUJ), and a fracture of the proximal phalanx of the big toe.
My hand is currently immobilized with a removable cast, while my foot is not being additionally stabilized.
During my follow-up appointment on June 7, the X-ray showed that the foot is healing, but the ulnar styloid is not healing.
It has been 5 weeks since the injury, but my toe is still somewhat swollen and I have difficulty bending it.
The range of motion for flexion, extension, and rotation of my right hand is almost normal, and I do not experience pain during regular activities, but I do feel pain when rotating to the limit or when bearing weight.

I have a few questions for you:
1.
Is it normal for my toe to still be swollen at this stage? I have tried walking since it doesn’t hurt much, but I am still hesitant to put weight on my big toe.

2.
Is the lack of healing of the ulnar styloid at this point considered a normal healing rate, or is my healing process too slow? Should I be concerned about the pain when bearing weight and rotating my hand, possibly indicating a triangular fibrocartilage complex (TFCC) injury, or could it simply be due to the fracture not healing? Given that it has been 5 weeks, is there a possibility that I might need surgery, or can I continue to observe?
3.
The doctor performed a manual examination and stated that there are no significant issues with the ligaments, and I can continue with conservative treatment.
I am scheduled to return for a follow-up in 6 weeks.
Will this conservative approach be effective? Is surgery necessary? I have attached the X-ray for your reference.
Thank you, doctor! https://imgur.com/a/A9V7CmQ

Xiao Ya, 20~29 year old female. Ask Date: 2021/06/19

Dr. Chen Yongxue reply Orthopedics

1.
Is it normal for my toe to still be swollen? I don't feel much pain and have tried walking, but I'm still hesitant to put weight on my big toe.
Answer: It is normal for the affected limb to be swollen until you can walk normally.
2.
Is it normal for the ulnar styloid to not have healed at this rate, or am I healing too slowly? Answer: The styloid process often takes time to heal, and many do not heal completely.
Additionally, the surgical outcome may not be optimal.
If pushing down and rotating causes pain, should I suspect a TFCC issue, or is it just due to the fracture not healing? Answer: It could be a TFCC problem.
3.
After five weeks, will I need surgery, or can I continue to observe? Answer: An MRI can be performed for further evaluation.
4.
The doctor performed a manual examination and said the ligaments are not significantly damaged, and I can continue to immobilize the area.
I should return for a follow-up in six weeks.
Will continuing conservative treatment be effective? Do I need surgery? Answer: Please follow the recommendations of your attending physician.
Thank you.

Reply Date: 2021/06/19

More Info

Hello Henry,
Thank you for your detailed inquiry regarding your recovery from the car accident injuries. I understand that you are experiencing significant concerns about your healing process, particularly with your right hand and foot. Let's address your questions one by one.

1. Swelling in the Toe: It is not uncommon for swelling to persist in a toe following a fracture, especially in the early stages of healing. The fact that you are experiencing some swelling without significant pain is a positive sign, indicating that the injury is likely healing. However, it is essential to monitor the swelling. If it worsens or if you experience increased pain, it would be prudent to consult your physician. Gentle range-of-motion exercises, as tolerated, can help reduce swelling and improve mobility.
2. Ulnar Styloid Fracture Healing: The healing time for fractures can vary significantly based on several factors, including the type of fracture, the location, your age, overall health, and how well you follow post-injury care instructions. Five weeks is a reasonable timeframe for initial healing, but if the ulnar styloid fracture has not shown signs of healing on X-ray, it may require further evaluation. Pain during rotation and when bearing weight could indicate that the fracture has not healed adequately or that there may be associated soft tissue injuries, such as a tear in the triangular fibrocartilage complex (TFCC). If the pain persists or worsens, further imaging, such as an MRI, may be warranted to assess for any soft tissue injuries.

3. Conservative Treatment: Continuing with conservative treatment is often the best approach in the absence of severe complications. If your physician has assessed that the ligaments are intact and there are no signs of significant complications, maintaining the splint and allowing time for healing is advisable. Typically, fractures of the ulnar styloid can heal well with conservative management, but if there is no improvement in the next few weeks, surgical intervention may be considered.
In summary, it is crucial to maintain regular follow-ups with your healthcare provider to monitor your healing progress. If you notice any changes in your symptoms, such as increased pain, swelling, or loss of function, do not hesitate to reach out to your doctor. They may recommend additional imaging or a referral to a specialist if necessary.

In the meantime, ensure you are following any prescribed rehabilitation exercises, maintaining a healthy diet rich in calcium and protein to support bone healing, and avoiding activities that could exacerbate your injuries.
Wishing you a smooth recovery, and please feel free to reach out with any further questions or concerns.

Best regards.

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