Recovery from Car Accident Fractures: Key Concerns and Next Steps

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 process, accompanied by a distal radioulnar joint dislocation, as well as a proximal phalanx fracture of the right big toe.
My wrist was immobilized with a removable short arm cast, and my foot was only secured with buddy taping, with no surgeries performed.
During my follow-up on June 7, the fracture line in my foot had become blurred, so the immobilization was removed, and I was allowed to walk.
However, my hand has not healed and continues to be immobilized.
It has been about 5 weeks, but my right big toe is still noticeably swollen, while the flexion and extension of my right hand are nearly normal, although there is pain at the limits of rotation, and I cannot bear weight on it.

I would like to ask the doctor:
1.
Is the ongoing swelling in my big toe due to the removal of the immobilization and walking? Could this cause the fracture to misalign?
2.
Regarding my hand, since the doctor is continuing to keep it immobilized, if there is still no improvement, will surgery be necessary?
Thank you, doctor.
Here is the reference image: https://m.imgur.com/a/YfeYjm8

Xiao Lu, 20~29 year old female. Ask Date: 2021/06/22

Dr. Chen Bochen reply Orthopedics

Hello, this question is exactly the same as the one you asked on the medical forum.
1.
A toe fracture can allow for normal walking after one month.
Using taping for stabilization can reduce pain, and there is not much concern about the fracture misaligning, but follow-up is necessary.
2.
The radioulnar joint often has poor healing; if it remains dislocated after 8 weeks, surgery is recommended.
If the dislocation has improved, rehabilitation is also necessary, as this area tends to have more complications after injury.

Reply Date: 2021/06/22

More Info

In the aftermath of a car accident, the recovery process from fractures can be complex and multifaceted, particularly when multiple injuries are involved. Your case, involving a fracture of the right ulnar styloid and a dislocation of the distal radioulnar joint, along with a fracture of the proximal phalanx of the right big toe, presents specific challenges that require careful management.

1. Understanding Swelling in the Big Toe
The persistent swelling in your right big toe could be attributed to several factors. After removing the immobilization, it is common for swelling to occur as the body begins to adjust to weight-bearing activities. The swelling may not necessarily indicate that the fracture has worsened or "moved," but it is essential to monitor it closely. Here are some considerations:
- Weight Bearing: Transitioning from a non-weight-bearing state to walking can lead to increased swelling, especially if the toe is not yet fully healed. It is crucial to ensure that you are not putting excessive pressure on the injured toe too soon.

- Inflammation: The body’s natural inflammatory response to injury can cause swelling. This is part of the healing process, but if the swelling is significant or accompanied by pain, it may require further evaluation.

- Complications: In some cases, complications such as a non-union or malunion of the fracture can lead to persistent swelling. If the swelling does not subside or worsens, it is advisable to consult your physician.

2. Hand Recovery and Potential Surgery
Regarding your right hand, the fact that it has not healed sufficiently after five weeks of immobilization raises some concerns. The continued pain during rotation and the inability to bear weight on the hand suggest that further evaluation is necessary. Here are some points to consider:
- Healing Timeline: Bone healing can vary significantly based on the type of fracture, the location, and individual factors such as age and overall health. While many fractures can heal within six to eight weeks, some may take longer, especially if there are complications.

- Surgical Intervention: If there is no improvement in your hand's condition, your physician may consider surgical options. Surgery may be necessary if there is a concern about the alignment of the bones or if there is a risk of complications such as nerve damage or chronic pain.

- Follow-Up Imaging: An MRI or CT scan may be warranted to assess the healing process and determine if there are any underlying issues that need to be addressed surgically.

Next Steps
1. Consult Your Physician: It is essential to keep your follow-up appointments and communicate any changes in your symptoms. If the swelling in your toe does not improve or if you experience increased pain, seek medical advice sooner rather than later.

2. Physical Therapy: Once cleared by your physician, engaging in physical therapy can help improve mobility and strength in both your hand and foot. A physical therapist can provide exercises tailored to your recovery stage, which can aid in reducing swelling and improving function.

3. Pain Management: Continue to manage pain with prescribed medications and consider discussing additional pain management strategies with your healthcare provider.

4. Monitoring: Keep an eye on any changes in swelling, pain levels, or functionality in both your hand and foot. Documenting these changes can provide valuable information for your healthcare team.

In conclusion, recovery from fractures sustained in a car accident requires a comprehensive approach that includes monitoring symptoms, engaging in rehabilitation, and possibly considering surgical options if healing does not progress as expected. Always prioritize communication with your healthcare provider to ensure the best possible outcome for your recovery.

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