Right Humerus Fractures: Treatment and Recovery Insights

Right humeral fracture?

Hello, Doctor.
I suffered a comminuted fracture of the distal humerus in my right arm on March 11.
I underwent surgery that afternoon at Taipei Veterans General Hospital in Neihu, where two plates and a screw were inserted for fixation.
The cast was removed on April 10.
Before the surgery, I noticed that I could not raise my thumb on its own, and my fingers were clenched and could not open independently.
The doctor mentioned that there was damage to the radial nerve.
During the surgery, the doctor observed the ulnar nerve and confirmed it was not severed, but the radial nerve was not visible, making it difficult to assess the extent of the injury.
After the cast was removed, I noticed my wrist was drooping.
I can make a fist with my fingers, but I cannot open them on my own.
My little finger feels weak and has a swelling sensation when bent down.
The other four fingers still have strength but also cannot be raised independently.

I have a few questions for you, Doctor:
1.
Currently, I am only undergoing physical therapy, which includes heat therapy and electrical stimulation.
What additional treatments would you recommend?
2.
The doctor mentioned starting occupational therapy after six weeks.
Is this timeline too long? Will occupational therapy cause any further damage to the nerves?
3.
The doctor scheduled a nerve conduction study for May 23, but I am very concerned about whether the nerves are severed and worried about delays in treatment.
Should I seek evaluation at another hospital?
4.
Since I have been seeing the same doctor, could you recommend a specialized orthopedic surgeon and rehabilitation center in Taipei? I am genuinely worried and disappointed about my current condition and fear that this situation may persist for a lifetime.
Thank you very much for your response.
I appreciate it.

Chen, 20~29 year old female. Ask Date: 2012/04/12

Dr. Li Wenlin reply Orthopedics

Nerve damage does not necessarily require reconnection; the recovery period may last from 3 to 6 months.
Nerve conduction studies can assess the extent of the injury, and if there is no recovery after 3 months, surgical exploration may be considered.

Reply Date: 2012/04/12

More Info

I'm sorry to hear about your injury and the challenges you're facing during your recovery. Right humerus fractures, especially those that are comminuted (shattered), can be quite complex and often require a multi-faceted approach to treatment and rehabilitation. Let's address your concerns one by one.

1. Current Treatment and Additional Recommendations: It's good to hear that you're currently undergoing physical therapy, which is crucial for regaining function after such an injury. In addition to heat therapy and electrical stimulation, I would recommend incorporating range-of-motion exercises as tolerated. Gentle stretching of the fingers and wrist can help prevent stiffness and improve mobility. If you haven't already, consider asking your physical therapist about specific exercises that target the wrist and fingers, as well as any modalities that might promote nerve healing, such as ultrasound therapy.
2. Timing for Occupational Therapy: Starting occupational therapy (OT) six weeks post-surgery is a common practice, especially in cases involving nerve injuries. While it may seem like a long wait, this timeline allows for initial healing and stabilization of the fracture. Engaging in OT too early could potentially exacerbate any existing nerve damage or lead to complications. Occupational therapy will focus on functional tasks and may include splinting to support the wrist and fingers, which can be beneficial for your recovery.

3. Nerve Conduction Study: The upcoming nerve conduction study (NCS) is an important step in assessing the extent of any nerve damage. It will help determine if there is any significant injury to the radial nerve or other nerves in the area. If you're concerned about the wait time for this test, you could consider seeking a second opinion at another facility, especially if you feel that your current care team is not addressing your concerns adequately. However, it's essential to maintain continuity of care, so weigh the benefits of a second opinion against the potential disruption in your treatment plan.

4. Finding a Specialist: If you're looking for a reputable orthopedic surgeon or rehabilitation center in Taipei, I recommend seeking out facilities that specialize in upper extremity injuries. Look for hospitals or clinics with a strong orthopedic department and a dedicated rehabilitation team. You might also consider asking your current physician for a referral to a specialist who has experience with nerve injuries and complex fractures.
It's understandable to feel anxious and frustrated about your recovery, especially when dealing with potential nerve damage. Remember that healing takes time, and it's essential to be patient with yourself throughout this process. Regular follow-ups with your healthcare team will be crucial in monitoring your progress and adjusting your treatment plan as needed.
In summary, continue with your physical therapy, prepare for your upcoming nerve study, and don't hesitate to seek additional opinions if you feel it's necessary. Your concerns are valid, and advocating for your health is an important part of the recovery process. Wishing you a smooth recovery and the best of luck in regaining full function of your hand.

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