Distal Radioulnar Joint Dislocation and Post-Surgery Complications

Distal radioulnar joint dislocation

Hello Doctor: I have mentioned this before, and I need your help again.
On March 27 of this year, I fell and displaced my wrist.
The doctor said I was too late to seek treatment; otherwise, I would only need a cast.
Instead, I underwent surgery to have a self-funded plate (with six screws) and an exposed steel pin inserted through the radius and ulna.
A month later, the exposed steel pin was removed during an outpatient visit.
About a month and a half later, my thumb and middle finger started to feel numb.
The doctor suggested that the plate might be pressing on a nerve, but it would take a year before it could be removed.
I was concerned that if the nerve was compressed for such a long time, it might be damaged, so I consulted another orthopedic surgeon.
He said it could be removed, and he did so, but he also mentioned that scar tissue might be pressing on the nerve.
After the plate was removed on July 13, the numbness in my hand improved by half, but it still persists.

I have a few questions for you:
1.
If the nerve was compressed for two months, is it likely to be injured permanently? If it is scar tissue pressing on the nerve, how should it be addressed?
2.
The doctor who removed the plate advised me to have the stitches taken out in 15 days; is that too long?
3.
Since I had a radius displacement, was it necessary to use a plate for fixation from the beginning, or would an exposed pin have sufficed? (I recall the initial doctor saying I was too late to seek treatment; otherwise, a cast would have been enough, and he asked if I had insurance.
Upon hearing that I had insurance, he immediately scheduled the surgery after the outpatient visit.)
4.
Over a year ago, I developed allergic rhinitis after a cold that was not treated properly.
Before the plate was inserted, I could tolerate it, but after the plate was inserted, I experienced severe post-nasal drip, and I needed to take medication to feel somewhat better.
I consulted an ENT specialist, who later conducted blood tests and reported that my index was 230, which is above the normal range.
I asked both the orthopedic and ENT doctors, and they said it was unlikely to be an allergy to the plate.
I trust their expertise, but I clearly worsened after the plate was inserted, and I felt significantly better after it was removed.
Is it true that plates do not cause allergic reactions in the human body? Thank you, Doctor.
I appreciate your hard work.

Huang S, 50~59 year old female. Ask Date: 2021/07/17

Dr. Chen Yongxue reply Orthopedics

1.
If a nerve has been compressed for 2 months, will it be permanently damaged? If it is scar tissue compressing the nerve, how should it be managed? ANS: Please start taking Vitamin B2.
2.
The doctor told me to have the metal plate removed in 15 days.
Is that too long? ANS: No, it is not.
3.
I have a radial bone displacement.
Was it unnecessary to use a metal plate for fixation from the beginning, and could it have been sufficient to use only external pins? (Because I recall the doctor mentioning that I came in too late; otherwise, a cast would have sufficed.
When I mentioned I had insurance, they scheduled surgery immediately after the outpatient visit.) ANS: Please consult your attending physician.
I cannot provide an ideal response without seeing the X-ray.
4.
I developed allergic rhinitis over a year ago after an untreated cold.
Before the metal plate was installed, I could tolerate it, but after the installation, I experienced severe post-nasal drip, and I needed to take medication to feel better.
I visited an ENT specialist, who later conducted blood tests and reported that my index was 230, which is above the normal range.
I asked both orthopedic and ENT doctors, and they said it is unlikely to be allergic to the metal plate.
I trust their expertise, but I clearly became worse after the plate was installed.
After the plate was removed, I felt much better.
Is it true that the metal plate does not cause allergies in humans? ANS: No, it does not.

Reply Date: 2021/07/17

More Info

Understanding the complications and management of distal radioulnar joint dislocation and subsequent surgical interventions is crucial for optimal recovery. Your situation involves a series of events following a wrist injury that led to surgical intervention, and it raises several important questions regarding nerve compression, surgical decisions, and potential allergic reactions to implants.

1. Nerve Compression and Recovery: When a nerve is compressed for an extended period, such as the two months you experienced, there is a risk of permanent damage. The extent of this damage can vary based on several factors, including the severity of the compression and the duration. If the nerve was compressed by the hardware or scar tissue, it might lead to symptoms like numbness or tingling, which you have described. If scar tissue is the culprit, treatment options may include physical therapy to improve mobility and reduce scar tissue formation, or in some cases, surgical intervention to release the nerve if conservative measures fail.

2. Timing for Suture Removal: Your concern about the timing for suture removal after the plate was taken out is valid. Typically, sutures are removed within 10 to 14 days post-surgery, depending on the healing process. If your doctor advised waiting 15 days, it is likely to ensure proper healing and minimize the risk of wound complications. However, if you have concerns about the timing, it’s always best to discuss them with your surgeon, as they can provide personalized advice based on your healing progress.

3. Initial Treatment Decisions: Regarding whether a plate was necessary for your initial treatment, it’s important to understand that surgical decisions are often based on the specific nature of the injury and the stability of the fracture. In some cases, if a fracture is stable and well-aligned, a cast may suffice. However, if there is significant displacement or instability, surgical fixation with plates and screws may be warranted. It sounds like your initial delay in treatment may have influenced the decision to opt for surgical intervention rather than conservative management.

4. Allergic Reactions to Implants: The concern about allergic reactions to metal implants, such as plates and screws, is a topic of ongoing research. While it is relatively rare for individuals to have allergic reactions to surgical implants, it can occur, particularly with certain metals like nickel. Symptoms of an allergic reaction can include localized swelling, redness, and discomfort. If you experienced significant symptoms after the implantation, it is worth discussing with your healthcare provider. They may consider allergy testing or alternative materials for future implants if necessary.

In summary, your experience highlights the complexities of managing wrist injuries and the potential complications that can arise from surgical interventions. It is essential to maintain open communication with your healthcare providers, seek second opinions when necessary, and advocate for your health concerns. If symptoms persist or worsen, further evaluation may be warranted to ensure that any underlying issues are addressed promptly. Your recovery journey is unique, and ongoing monitoring and adjustments to your treatment plan will be key to achieving the best possible outcome.

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