Recovery from Open Comminuted Wrist Fractures

Open comminuted fracture of the wrist involving the ulnar and radial bones?

Hello, I had a car accident in January and suffered an open comminuted fracture of my left wrist.
Both my ulna and radius were broken, and I had six steel pins inserted, which are external pins placed on the skin.
It has been over three months now.
How long will it take before I can have the pins removed? Why is it taking so long? After the pins are removed, how long will it take for the wounds to heal? How long will it be before I can use my injured hand for daily activities, such as brushing my teeth, washing my face, or picking things up? Can I still dance? I am a dance student, and I'm worried that dancing might cause my hand to break again.
How long will rehabilitation take before my hand can regain normal function? Additionally, how long will it be before I can perform weight-bearing activities, such as push-ups? Will my hand be less flexible in the future? I am very concerned about the potential loss of mobility in my hand.
My primary physician said that I did not injure my nerves or ligaments, so I should be fine.
However, when I consulted another doctor (not the one who performed my surgery), he reviewed my X-rays and mentioned that due to the fragmentation, my hand might not regain full mobility.
Why are there differing opinions between these two orthopedic surgeons? Since I am a dancer, I am particularly anxious about this and fear that my hand might become unusable.
Thank you.

Gua Er, 20~29 year old female. Ask Date: 2009/04/23

Dr. Shi Guozheng reply Orthopedics

The external fixation pins can only be removed after the fracture has healed, which typically takes about three to four months, and no longer than six months at most.
Once removed, the wound will usually heal within about a week.
After that, rehabilitation is necessary until the wrist and hand can move freely.
The rehabilitation period may also last from three to six months.
If the fracture is comminuted, there may be functional impairments even after healing.

Reply Date: 2009/04/23

More Info

Recovering from an open comminuted wrist fracture, especially one involving both the radius and ulna, can be a complex and lengthy process. Given your situation, where you sustained significant injuries in a car accident and underwent surgery with the placement of six external pins, it’s understandable to have concerns about your recovery timeline and future functionality of your wrist.

Recovery Timeline
Typically, the healing process for a comminuted fracture can take several months, often ranging from 3 to 6 months or longer, depending on various factors such as the severity of the fracture, your age, overall health, and adherence to rehabilitation protocols. The presence of open fractures complicates the healing process due to the risk of infection and the need for careful monitoring.
1. Pin Removal: The timing for the removal of the pins usually depends on the healing progress observed through follow-up X-rays. Generally, pins are removed when the bone shows adequate signs of healing, which can take anywhere from 8 to 12 weeks post-surgery. However, in some cases, it may take longer if the fracture is particularly complex or if there are complications.

2. Wound Healing: After the pins are removed, the surgical site will also need time to heal. This could take an additional few weeks, during which you should avoid putting stress on the wrist.

Functional Recovery
Once the pins are removed and the wound has healed, you can gradually start using your wrist for daily activities. However, it’s crucial to follow your healthcare provider's recommendations regarding the timeline for resuming specific activities:
- Basic Activities: You may be able to start light activities, such as brushing your teeth or washing your face, within a few weeks after pin removal, but this should be done cautiously and without causing pain.

- Dancing and Physical Activity: Given your background in dance, it's understandable that you want to return to this activity. However, jumping back into dance too soon could risk re-injury. It’s advisable to wait until you have regained sufficient strength and range of motion, which may take several months post-pin removal. Engaging in physical therapy can help facilitate this process.

- Strength and Mobility: Rehabilitation will play a critical role in restoring function. Physical therapy typically begins with gentle range-of-motion exercises and progresses to strengthening exercises. The timeline for returning to more strenuous activities, like push-ups or other weight-bearing exercises, will depend on your recovery progress and should be guided by your physical therapist.

Concerns About Long-term Functionality
It’s natural to worry about the long-term functionality of your wrist, especially given the conflicting opinions from different doctors. While one physician may express concerns about potential stiffness or loss of mobility due to the comminuted nature of the fracture, another may be more optimistic based on your lack of nerve or ligament damage.
- Rehabilitation: Engaging in a structured rehabilitation program is essential. This will not only help restore strength and flexibility but also address any concerns about stiffness or loss of function.
- Monitoring Progress: Regular follow-ups with your orthopedic surgeon and physical therapist will help monitor your healing and adjust your rehabilitation plan as needed.

Conclusion
In summary, recovery from an open comminuted wrist fracture is a gradual process that requires patience and adherence to medical advice. While the timeline for full recovery can vary, focusing on rehabilitation and following your healthcare provider's recommendations will be key to regaining functionality. If you have specific concerns about your recovery or the potential for long-term issues, don’t hesitate to discuss these with your healthcare team, as they can provide tailored advice based on your unique situation.

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