Complications After Distal Radius Fracture Surgery

Distal radioulnar joint dislocation

Hello Doctor: I am the person who previously raised a question in #169644.
I have a displaced fracture of the right radius and ulna, for which I underwent surgery to have a plate and screws inserted (self-funded).
Two months later, I experience numbness in my thumb, index finger, and middle finger (the ring finger near the middle finger also feels numb).
The doctor mentioned that it might be due to the plate compressing a nerve in that area.
Later, I consulted another orthopedic surgeon at the Veterans General Hospital, who indicated that this situation could be caused by the plate pressing on the nerve or possibly by scar tissue inside compressing it.
I understand this, but the doctor also mentioned that they would need to cut the ligament in the carpal tunnel from the original incision towards the palm.
They later stated that I would need to wait until August to assess the situation regarding surgery, and it might not even be possible to operate.
It seems like the doctors are not very keen on performing surgery to remove the plate.
I am now worried that prolonged pressure will worsen the condition.
May I ask the doctor: 1.
How can I request the doctor to remove the plate from my hand? (I am experiencing constant numbness.) 2.
Do I need to undergo carpal tunnel release surgery? I did not have this issue before; it started after the plate was inserted.
I had a displacement, not a fracture; is it necessary to have a plate inside? Thank you, doctor, for your hard work.

Huang S, 50~59 year old female. Ask Date: 2021/07/11

Dr. Chen Yongxue reply Orthopedics

As mentioned in your letter, it is likely carpal tunnel syndrome.
The causes could include scarring, prolonged pressure, or conditions such as diabetes, among others.
Therefore, it is possible to perform a decompression surgery while removing the plate.

1.
How can I ask my doctor to remove the plate from my hand? (It feels numb all day)
ANS: If the fracture has healed, the plate can be removed earlier.
2.
Do I need to undergo ligament release for carpal tunnel syndrome?
ANS: This is the best treatment for carpal tunnel syndrome; the function of this ligament is not crucial, and the surgery will not affect your daily life.
Since I did not have this issue before, it started after the plate was installed, and I have a displacement rather than a fracture.
Is it necessary to have the plate inside?
ANS: As you mentioned, it is a "fracture" of the radius and ulna with displacement, and the plate is used for stabilization in treatment.

Reply Date: 2021/07/11

More Info

After undergoing surgery for a distal radius fracture, it is not uncommon to experience complications, particularly if you are experiencing symptoms such as numbness in your thumb, index, and middle fingers. These symptoms can be indicative of nerve compression, which may arise from several factors related to the surgical procedure and recovery.

1. Nerve Compression: As your doctor mentioned, the numbness could be due to the metal plate pressing against a nerve, or it could be caused by scar tissue formation (adhesions) that develops post-surgery. The median nerve, which runs through the carpal tunnel in the wrist, can be particularly susceptible to compression, leading to symptoms consistent with carpal tunnel syndrome. This condition can cause numbness, tingling, and weakness in the hand.

2. Surgical Intervention: If the numbness persists and significantly impacts your daily life, it is reasonable to consider surgical options. The decision to remove the metal plate or to perform a carpal tunnel release should be made in consultation with your orthopedic surgeon. If the plate is indeed causing nerve compression, removing it may alleviate your symptoms. However, if the numbness is primarily due to scar tissue, a carpal tunnel release might be necessary to relieve pressure on the median nerve.

3. Timing of Surgery: It is understandable to feel anxious about waiting for surgery, especially when experiencing ongoing symptoms. However, it is essential to allow adequate time for healing and to monitor the situation. Your surgeon may want to observe your symptoms over a period to determine if they improve with conservative management or if surgical intervention is warranted.

4. Requesting Surgery: To advocate for the removal of the plate, you should express your concerns clearly to your surgeon. Document your symptoms, how they affect your daily activities, and any changes you notice. This information can help your doctor understand the urgency of your situation. If your current surgeon is hesitant, you might consider seeking a second opinion from another orthopedic specialist who may have a different perspective on your case.

5. Need for Carpal Tunnel Release: If your symptoms began after the surgery and are directly related to the placement of the plate, it is reasonable to consider that the plate may not have been necessary, especially if the fracture was stable without it. However, the decision to place hardware is often based on the surgeon's assessment of the fracture's stability and the potential for proper healing. If the plate is causing issues, a release of the carpal tunnel may be necessary to alleviate the symptoms.

In summary, it is crucial to maintain open communication with your healthcare provider regarding your symptoms and concerns. If the numbness continues to be a problem, discussing the possibility of removing the plate and addressing any potential nerve compression through a carpal tunnel release is warranted. Your quality of life and functional recovery should be the primary focus of your treatment plan.

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