Broken Wrist? Here’s Why Simply Casting It Might Not Be Enough
Ouch! You’ve broken your wrist – probably from a fall, sports injury or other accident – and now you’re at the ER, where doctors will likely set the fractured bone back in place manually and send you home in a cast. For many patients, that’s all they need . . . but lingering pain and dysfunction may await those who instead should have undergone a specialized type of surgery to properly repair the break.
To explain the minimally invasive operation – known medically as arthroscopically assisted open reduction and internal fixation of a distal radius fracture – we’ve asked Dr. Mark E. Pruzansky to lend insight from his decades of experience as a New York City-based triple Board-Certified physician and recognized Top Doctor. Dr. Pruzansky’s three board certifications place him among the top 2.1% of hand surgeons worldwide, where he seamlessly blends sports medicine into the practice of hand, wrist and elbow surgery.
“Broken pieces of bone can slip in a cast. A cast is just on your skin and the bones can move under the skin,” he explains. “But by directly visualizing the joint surface with a surgical instrument called an arthroscope and using little tools directly on the bone pieces, rather than pulling solely on the pieces from the outside, I’m going to be assured that the pieces are in the best possible alignment before I fix them in place with plates and screws.”
“Broken pieces of bone can slip in a cast. A cast is just on your skin and the bones can move under the skin.”
“Direct visualization is better than X-ray confirmation – it’s more accurate,” Dr. Pruzansky adds, noting that an arthroscopic approach allows surgeons to see the inside of the joint using light and magnification.
Fractures of the distal radius, otherwise known as a broken wrist, means the larger of the two bones of the forearm has broken near the end. Arthroscopic surgery comes into play for more severe breaks, when the bone is so far out of place it can’t be corrected or properly manipulated back into place from outside the joint.
Determining the right treatment, and whether arthroscopic surgery offers an optimal outcome, relies on a careful approach that often includes CT or MRI scans along with standard X-rays, Dr. Pruzansky says. These images can pinpoint if there’s a gap or step-off between broken bones – and if so, just how big that is – as well as how many pieces of broken bone there are.
The surgery, which usually takes less than an hour, is done with regional anesthesia that numbs only the arm so patients can remain awake. Two or three small incisions are made, through which a camera and tiny surgical instruments are inserted. The surface of the broken bone is realigned within a margin of less than 2 millimeters and fixed in place with surgical hardware.
Arthroscopic surgery also enables surgeons to remove stray shards of bone, shave down jagged cartilage and repair ligaments – other key benefits that simply casting or operating on a broken wrist can’t address.
And while broken wrists and other fractures require immediate attention, Dr. Pruzansky advises looking for certain attributes in a hand surgeon or orthopaedic surgeon if you have a choice. It’s wise to find a Board-Certified physician, of course, but also to read testimonials from patients and online reviews. Research how many such procedures they’ve done similar to yours, he says.
“What’s on paper isn’t enough,” Dr. Pruzansky adds. “You may want references from someone who’s used them, whether an internist or friends who were happy with their results.”