Post-Surgery Concerns: Radial Bone Displacement and Healing

Post-operative displacement of a radius fracture?

Due to a car accident on September 22, I sustained a fracture of the distal radius with 1/3 displacement that was initially missed in the emergency department.
It was later discovered during a follow-up visit to the orthopedic clinic.
After nearly two months, on December 7, I underwent surgery where an absorbable bone screw was placed for reduction, along with artificial bone grafting.
The doctor mentioned that the surgery went smoothly and that I could start the healing process.

Three weeks post-surgery, during a follow-up X-ray, the doctor noted that the alignment looked good and that healing had begun, allowing me to remove the splint and start moving my wrist.
I diligently worked on rehabilitation.
However, five weeks post-surgery, during another follow-up X-ray, it was observed that the position of the bone appeared different; it seemed to have shifted slightly upward, and the gap between the fractured bone and the adjacent bones had increased, although the screw remained in its original position.
The doctor indicated that the plane of the radius still appeared horizontal and should not pose any issues, suggesting that it might be an artifact of the imaging angle.
I would like to know if this situation indicates bone displacement.
If there is displacement, can it be manually reduced? Would displacement lead to malunion or nonunion of the bone? Regarding the X-ray, it seems there is a gap between the bones; will they eventually fuse together? When I gently touch the area of the fracture, I notice a gap between the fractured bone and the surrounding bone.
The doctor advised me to practice wrist rotation, but I still hear a clicking sound.
Does this indicate that the bone has not healed properly? What could be the implications? Will the bone continue to heal? I am very concerned about the condition of my wrist.
Thank you, doctor, for taking the time to respond.
Additionally, during the car accident, I also sustained a fracture of the mandible, which was stabilized with a titanium alloy plate.
The doctor mentioned that the bone has healed, but stated that the facial bone plate is typically not removed.
Could you explain why other areas may require removal while the facial area does not? Since I am only 20 years old, what uncertainties might arise if the plate is not removed in the future? Does the doctor recommend removal?

Bobo, 20~29 year old female. Ask Date: 2023/01/14

Dr. Chen Yongxue reply Orthopedics

Hello, could this situation indicate a bone displacement? Is it possible, as the doctor mentioned, that it is just an issue with the imaging angle? If there is a displacement, can it be manually reduced? Would a displacement lead to the bone healing improperly or not healing at all? Regarding the X-ray, it appears that there was a gap between the bones previously; will they eventually fuse together? I noticed when I gently touch the area of the bone that there is a gap between the fractured bone and the previous bone.
The doctor advised me to practice rotating my hand, but I still hear a cracking sound; does this mean the bone hasn't healed properly? Ideally, there shouldn't be any palpable gaps; what you are feeling might be related to the joint.
Will the bone continue to grow? It should, but follow-up is necessary.
Additionally, during the car accident, there was a fracture in the anterior mandible, and a titanium alloy plate was used for fixation.
The doctor said the bone has already healed, but he mentioned that facial bone plates are not typically removed.
Could you explain why other areas require removal while the facial area does not? The blood circulation in the face is very good, so removal is unnecessary.

Reply Date: 2023/01/14

More Info

After a radial bone fracture, particularly one that involves displacement, concerns about healing and potential complications are common. In your case, it sounds like you experienced a significant injury, and while the initial surgery went well, the subsequent X-ray results have raised some questions about the alignment and healing of your bone.

Firstly, it is important to understand that bone healing is a complex biological process. After a fracture, the body goes through several stages of healing, which include inflammation, soft callus formation, hard callus formation, and bone remodeling. The fact that your doctor noted that the bone is starting to heal and that the position looks good is a positive sign. However, the changes you observed in the X-ray, such as the apparent displacement or increased gap between the bones, can be concerning.

1. Displacement and Healing: If the X-ray shows that the bone appears to be displaced or misaligned, it is essential to discuss this with your orthopedic surgeon. Sometimes, what looks like a displacement on an X-ray can be attributed to the angle of the imaging or the natural healing process. If there is a true displacement, your doctor will assess whether it requires intervention. In some cases, minor displacements can heal without the need for further surgery, as the body can realign itself during the healing process.

2. Potential for Malunion or Nonunion: Concerns about the bone healing improperly (malunion) or not healing at all (nonunion) are valid. Factors such as the quality of the fracture fixation, the patient's overall health, and adherence to rehabilitation protocols can influence healing. If there is a significant gap between the bones, it may impede proper healing, leading to malunion. Your doctor will monitor the healing process closely and may recommend further imaging or interventions if necessary.

3. Physical Symptoms: The "popping" or "cracking" sounds you hear when moving your wrist can be related to several factors, including the movement of tendons over the bone or the presence of scar tissue. While these sounds can be concerning, they do not necessarily indicate that the bone has not healed properly. However, if you experience pain or instability, it is crucial to report these symptoms to your doctor.

4. Long-term Considerations: Regarding your jaw injury and the titanium plate, it is common practice to leave plates in place unless they cause discomfort or complications. The reason for this is that the bone often grows around the plate, and removing it can sometimes lead to additional complications. In your case, since the jawbone has healed well, your doctor may feel that the benefits of leaving the plate in place outweigh the risks of removal.

5. Future Monitoring: It is essential to maintain regular follow-ups with your orthopedic surgeon to monitor the healing process. They may recommend physical therapy to improve mobility and strength in your wrist, which can also aid in the healing process.

In summary, while your concerns about the healing of your radial bone fracture are valid, it is crucial to maintain open communication with your healthcare provider. They can provide the best guidance based on your specific situation and imaging results. If there are any changes in symptoms or if you have ongoing concerns, do not hesitate to reach out to your doctor for further evaluation.

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