Fractures of the Wrist by Mr G J Packer, Orthopaedic Surgeon in Essex, UK.

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.

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This page was last updated on 03/Oct/2007