Common Problems
After Surgery
The commonest problem following
fractures of the wrist is mal-union, that is when the radius heals
in the wrong position. As indicated above this is usually due to the
fact that the broken part of the radius falls back into the hole on
the back of the wrist left by the dorsal comminution. This often
results in the radius being shorter than the ulna and is often
combined with tilting backwards of the wrist. This results in both
deformity (the wrist appears misshapen) and pain due to the ulna
catching on the bones of the wrist (the carpal bones). If this
occurs it is possible to correct this by means of surgery.
There are a number of methods used
to achieve this but in general terms they involve either re-breaking
the radius and returning it to its original shape or changing the
ulna to make it fit the new shape of the radius. Re-breaking the
radius (known as an osteotomy) will usually involve the use of a
bone graft to hold the bone in position until it heals and this is
then supported by either a plate or an external fixator. Since
however angularly stable devices have become available the use of
bone graft is becoming less common and it is my practice now to try
and avoid bone graft as these angularly stable implants are strong
enough to allow use of the plate alone without bone grafting. This
is obviously decided at the time of operation. The alternative to
this is to make the ulna shorter by removing a piece of bone and
putting a plate on it to hold the ulna in place until such time as
it heals or it may be matched to the size of the radius by trimming
it to fit (a matched ulna procedure). As can be imagined this is a
specialised part of Orthopaedic or Hand surgery and your surgeon may
decide to send you to a surgeon who has a specialist interest or
experience in this field.
One other important part of wrist fracture surgery is
that fractures of the wrist are often associated with injuries to
the ligaments of the wrist. This can be quite difficult to diagnose
in the initial stages and either immediately after the fracture or
at some time later if there is the suggestion that the ligaments of
the wrist are involved, it may be necessary to further investigate
this. There are a variety of methods available to investigate wrist
problems further including further X-rays although these do not show
soft tissues or MRI and CT scanning. It is more common these days
that wrist surgeons will want to examine the wrist surface itself
and a common way to achieve this is by use of wrist arthroscopy when
a small device is inserted into the wrist using keyhole surgery to
examine the surface of the wrist joint and to assess the nature of
any damage to the joint surfaces and to the ligaments or to another
structure known as the triangular fibro cartilage complex (TTCC)
which has a similar structure to the cartilage of the knee and may
be damaged in a similar way. Wrist arthroscopy is a specialist form
of wrist surgery. It is however becoming a more commonly performed
operation these days. It is traditionally performed using a rigid
arthroscope. However, at Southend Hospital over the last two years
we have been pioneering the use of a flexible scope which is much
smaller than the current scope (approximately half the size) and to
give an idea of the sizes involved, the current scope used is 1.2mm
in diameter which is approximately the thickness of a 5 pence
piece. Our initial results with this procedure have been presented
at International Meetings including the International Federation of
Surgery for the Hand Meeting in Sydney, Australia in March of 2007.
The other advantage is that this method can be performed under local
anaesthesia if the patient does not wish to have a general
anaesthetic. |