Join Early Retirement Today
View Poll Results: What should Wab do for his broken wrist?
surgery 7 29.17%
cast 13 54.17%
let it flap in the breeze 4 16.67%
Voters: 24. You may not vote on this poll

Reply
 
Thread Tools Search this Thread Display Modes
Poll: surgery or cast?
Old 01-11-2007, 06:37 PM   #1
Thinks s/he gets paid by the post
wabmester's Avatar
 
Join Date: Dec 2003
Posts: 4,459
Poll: surgery or cast?

I always enjoy the candid medical discusions here, so here's my story of gore.

Saw an orthopedic surgeon. He agrees my wrist is broken -- distal radius fracture.

He says if I were 19, a cast would be a no-brainer. If I were 65, a metal plate would be a no-brainer. But I'm 45, so it's my call.

This highly recommended Harvard-educated doc wants to cut me open and put this shiny titanium plate in me:

shiny!

He says it will increase the odds of a good outcome, quick recovery, and full flexibility. As a surgeon, he'd want one for himself in my situation.

But, he says 7 out of 10 orthos would recommend a cast for me. And he gives a cast a 75% chance of a good outcome.

Worst case: cast, then chronic pain, then more complicated surgery to correct my bad choice.

I loathe the idea of surgery, but chronic pain doesn't thrill me either. I'm getting another opinion in a couple days....

__________________

__________________
wabmester is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Re: Poll: surgery or cast?
Old 01-11-2007, 06:51 PM   #2
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Moemg's Avatar
 
Join Date: Jan 2007
Location: Sarasota,fl.
Posts: 10,033
Re: Poll: surgery or cast?

I've worked with several orthopedic doctors .Go with the surgery .If it doesn't heal right in a cast you'll still need surgery .More complicated surgery .The real shiny plates are small and give you the best chance of good mobility .
__________________

__________________
Moemg is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 06:59 PM   #3
Thinks s/he gets paid by the post
lazygood4nothinbum's Avatar
 
Join Date: Feb 2006
Posts: 3,895
Re: Poll: surgery or cast?

i'm voting cast because that gives you a whole new hobby of getting people to sign it.
__________________
"off with their heads"~~dr. joseph-ignace guillotin

"life should begin with age and its privileges and accumulations, and end with youth and its capacity to splendidly enjoy such advantages."~~mark twain - letter to edward kimmitt 1901
lazygood4nothinbum is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 07:22 PM   #4
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
TromboneAl's Avatar
 
Join Date: Jun 2006
Posts: 11,197
Re: Poll: surgery or cast?

Quote:
He says it will increase the odds of a good outcome, quick recovery, and full flexibility. As a surgeon, he'd want one for himself in my situation.
If you talk to the salesman at Circuit City he'll say "These are the speakers that I have in my house." If you talk to a surgeon, he'll say 'I'd have the surgery.'"
__________________
Al
TromboneAl is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 07:25 PM   #5
Full time employment: Posting here.
 
Join Date: May 2004
Location: Worldwide
Posts: 913
Re: Poll: surgery or cast?

distal radius fracture...? I am not a doc., but all this tells me is that you have a fracture that's effecting the radius of the joint. The wrist is a complicated joint with many little bones working like a gearbox. Think about it. How many joints in your body have the same flexiblility as your wrist? Not many if any.

I, too, broke my wrist. It was the scafoid bone. A tiny bone, yet it seems we cannot do without any of them functioning correctly. In my case, I had to have surgery with a bone graft. But this thread is about what's right for you.

IMO, I would seek out the best hand surgon you could find, including professional sporting team surgeons. They are the ones who deal with these injuries regularly and it's their goal to "keep you in the game" meaning to bring you back to full recovery ASAP, without any pain.

Good Luck to you.

Billy
www.RetireEarlyLifestyle.com
__________________
In 1991 Billy and Akaisha Kaderli retired at the age of 38. They have lived over 2 decades of this financially independent lifestyle, traveling the globe.
Billy is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 07:37 PM   #6
Thinks s/he gets paid by the post
simple girl's Avatar
 
Join Date: Sep 2006
Posts: 2,505
Re: Poll: surgery or cast?

Quote:
Originally Posted by Billy
IMO, I would seek out the best hand surgon you could find, including professional sporting team surgeons. They are the ones who deal with these injuries regularly and it's their goal to "keep you in the game" meaning to bring you back to full recovery ASAP, without any pain.
I second that. Definitely seek out a hand surgeon. Wrist fractures can be nasty. If it doesn't heal properly, you will have a very difficult time with daily activities.

FYI, you'll need rehab after either cast or surgery...it's also very critical for optimal outcomes.
__________________
simple girl
less stuff, more time

(49, married; DH 53. I am fully retired as of 2015 (well ok, I still work part-time but only because I love the job and have complete freedom to call off if I want to travel with hubby for work), DH hopes to fully retire 2018 when he turns 55 to access 401K penalty-free...although he may decide to do part-time consulting)
simple girl is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 08:15 PM   #7
Thinks s/he gets paid by the post
wabmester's Avatar
 
Join Date: Dec 2003
Posts: 4,459
Re: Poll: surgery or cast?

Good stuff. There is an ortho group downtown that handles all of the regional sports teams, but I didn't see a wrist specialist in their group.

FWIW, the radius is technically one of the forearm bones (with its pal, the ulna). The distal end interfaces at the wrist. Apparently, that end is not as strong as the rest of the bone. So, this fracture is pretty common (called a FOOSH for fall on an outstretched hand).
__________________
wabmester is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 09:27 PM   #8
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,018
Re: Poll: surgery or cast?

Wab, here's what MD Consult says about your wrist fracture. If you would like me to explain the gobbledegook or to check out individual references, just send me a PM.

Meadbh
Disclaimer: I'm not an orthopedic surgeon!



The Wrist: Common Injuries and Management

Katrina Parmelee-Peters, MD
Scott W. Eathorne, MD

DISTAL RADIUS FRACTURE
Distal radius fractures are very common in sports. This injury typically occurs with a FOOSH with hyperextension, impacting the distal radius. The athlete presents with pain, swelling, ecchymosis, and tenderness about the wrist. Initial radiographs should include PA, lateral, and oblique views of the wrist. The examiner needs to determine the type of distal radial fracture and assess displacement, shortening, and intra-articular involvement. The goal of treatment is to correct and maintain radial inclination, palmar tilt, length, and congruity of the distal radial articulations (carpal and ulnar).

A Colles' fracture, the most common distal radius fracture, is a closed fracture of the distal radial metaphysis in which the apex of the distal fragment points in the palmar direction and the hand and wrist are dorsally displaced (Fig. 7). This fracture usually occurs within 2 cm of the articular surface. Colles' fractures are common in adults and rare in children, because children tend to sustain injuries through the distal radial physis.

Stable distal radius fractures may be managed in a short arm cast. All others should be referred for reduction and fixation. A stable distal radius fracture is extra-articular, without comminution, and with minimal or no displacement, which, when reduced to anatomical alignment, does not redisplace back to the original deformity [30]. For optimal outcome, it is important that anatomic alignment of the radius is maintained (either at presentation or with reduction); however, authors differ slightly on the definition of acceptable anatomical alignment. Certainly, fractures must be referred for orthopedic consultation if there is greater than 20° dorsal tilt, loss of radial inclination (20° to 30° need to be maintained), articular step-off greater than 2 mm, or radial shortening greater than 5 mm (Fig. ) [31]. Maintaining radial inclination of 20° to 30°, 4° to 8° palmar tilt, and radial shortening no greater than 2 mm is recommended by Rettig and Trusler [32]. Some texts report that less than 20° of dorsal tilt is stable for closed reduction of a Colles' fracture [30], [33]; however, the reduction needs to be close to anatomic alignment. Laboratory studies demonstrate that alteration of palmar inclination by 20° or more can cause dorsal shift in the scaphoid and lunate, leading to decreased range of motion and high pressure areas on the distal radius [34]. In an individual who normally has 11° of palmar tilt, the maximum acceptable alteration in palmar inclination is 9° of dorsal tilt. Clinical studies also demonstrate that patients who have excessive dorsal tilt are more likely to have poor outcome. McQueen and Jaspers [35] reported on 30 patients who had a Colles' fracture at 4 years follow-up. Patients who had as little as 10° dorsal tilt were much more likely to have pain, stiffness, weakness, and poor function.

Fractures may “settle” or displace in the cast. If healing occurs with a displaced fracture fragment, wrist range of motion will be compromised. A distal radius fracture that is considered stable is managed with a short arm cast, but must be followed with weekly radiographs for at least 3 weeks to ensure that the fracture does not displace in the cast. If cast immobilization is not able to maintain less than 10° of dorsal radial inclination and less than 5 mm radial shortening, internal fixation is recommended [30].

Some surgeons are electing to manage even traditionally stable distal radius fractures with internal fixation. The reason seems to be twofold. The closer to anatomical alignment the fracture is maintained, particularly in palmar tilt, the better the outcome. Also, “stable” fractures may displace with cast immobilization, termed “secondary instability,” and require internal fixation. In a prospective radiological study performed on 170 Colles' fractures that were treated with closed reduction and cast immobilization [36], 29 fractures displaced, requiring further reduction and external fixation. Seventeen additional fractures suffered malunion, with significant increase in radial angulation and decrease in radius length.

__________________
Meadbh is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 11:46 PM   #9
Full time employment: Posting here.
 
Join Date: Jan 2006
Posts: 899
Re: Poll: surgery or cast?

Minor change in topic.

WAB, is this from roller blading? Were you wearing wrist guards?

I got a new pair of knee guards and wrist guards for Christmas.

MB
__________________
mb is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-11-2007, 11:53 PM   #10
Thinks s/he gets paid by the post
wabmester's Avatar
 
Join Date: Dec 2003
Posts: 4,459
Re: Poll: surgery or cast?

Roller skating on the old-school quads with my 3-year-old at a rink. Backward fall landing solely on one hand.

I've read that even a wrist guard wouldn't have helped much in that kind of compression fall. BTW, do you know how they test wrist guards? Hint: donate your body to science.
__________________
wabmester is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 12:06 AM   #11
Full time employment: Posting here.
 
Join Date: Jan 2006
Posts: 899
Re: Poll: surgery or cast?


Quote:
Originally Posted by wab
Roller skating on the old-school quads with my 3-year-old at a rink. Backward fall landing solely on one hand.

I've read that even a wrist guard wouldn't have helped much in that kind of compression fall. BTW, do you know how they test wrist guards? Hint: donate your body to science.
Ouch! Think I'll wear them anyway!

MB
__________________
mb is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 12:14 AM   #12
Thinks s/he gets paid by the post
 
Join Date: Feb 2003
Location: Mesa
Posts: 3,588
Re: Poll: surgery or cast?

I'm voting for amputation.
__________________
sgeeeee is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 12:36 AM   #13
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Brat's Avatar
 
Join Date: Feb 2004
Location: Portland, Oregon
Posts: 5,914
Re: Poll: surgery or cast?

I vote for the hand surgeon. And, since we have so many teaching hospitals around here make sure that "the master" is doing the job. This is one of those injuries where timeliness is more important than location. If the local talent is booked look in Portland, SF or LA. Flights are cheap.
__________________
Duck bjorn.
Brat is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 02:00 AM   #14
Recycles dryer sheets
 
Join Date: Jan 2004
Posts: 179
Re: Poll: surgery or cast?

Hi Wab:

Sorry to hear about your wrist injury. Hope you make the best decision and that everything goes well. Wishing you a speedy recovery.

Toejam

__________________
Toejam is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 09:04 AM   #15
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Moemg's Avatar
 
Join Date: Jan 2007
Location: Sarasota,fl.
Posts: 10,033
Re: Poll: surgery or cast?

By the way the orthopedic doctors that I worked for were sports medicine .They are the doctors for the Us soccer team ,many of the tennis stars , the Pittsburg Pirates and (though they were lousy this year )the Tampa bay buccaneers
So I'm still voting surgery !
__________________
Moemg is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 10:53 AM   #16
Recycles dryer sheets
 
Join Date: Dec 2006
Posts: 347
Re: Poll: surgery or cast?

Sorry about your fall!! Just one more thing if you decide surgery the installed plate/screws etc may well have you setting off metal detectors in airports. Make sure you get a laminated card from the Doc and carry it while flying. Noting more annoying than setting off the metal detectors in the security line.
__________________
USCG regulations say you have to go out. They don't say anything about coming back.
USK Coastie is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 11:23 AM   #17
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,275
Re: Poll: surgery or cast?

I read how you got the injury....

A long number of years ago... my boss was roller skating with his kid... did the same thing, falling backwards.. but he put both arms down to break his fall...and broke both arms....

He got the metal pins in each arm with the bridge or whatever it is called outside his arm... Kids were scared when they saw him coming with these things hanging on his arm... I had heard this is one of the most common ways adults break their arm...
__________________
Texas Proud is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 01:04 PM   #18
Confused about dryer sheets
 
Join Date: May 2006
Posts: 3
Re: Poll: surgery or cast?

Hi WAB,

I had this same type of wrist break in August after pulling ivy in the garden, losing my balance and falling backward on a terrace and down into a cement stairwell. The wrist was set and then they took another XRAY and recommended I have surgery to insert a titanium plate to hold bones in place. They put titanium in my wrist area to hold everything together. I was in a cast about 3 weeks and then started going to a physical therapist specializing in hand/wrist injuries. I wore a wrist brace for another 3-6 (?) weeks.

I was in physical therapy for two months and now have almost complete range of motion of hand and wrist back. I credit the skilled physical therapist with getting my range of motion back to my fingers, hand and wrist.

I was told there would be less likelihood of osteo arthritis with surgery and so far no residual pain. Also I was probably in a cast a much shorter time which seems important to getting range of motion back. Initially I had no range of motion in fingers, hand and wrist. I could barely wiggle two fingers, that was about it.
__________________
marpea is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 06:29 PM   #19
Thinks s/he gets paid by the post
wabmester's Avatar
 
Join Date: Dec 2003
Posts: 4,459
Re: Poll: surgery or cast?

Quote:
Originally Posted by Texas Proud
He got the metal pins in each arm with the bridge or whatever it is called outside his arm... Kids were scared when they saw him coming with these things hanging on his arm...
Cool!



Those have been pretty much obsoleted by the internal volar plates that my doc wants to insert. Still barbaric, but not quite as freakish as the external fixator.
__________________
wabmester is offline   Reply With Quote
Re: Poll: surgery or cast?
Old 01-12-2007, 06:35 PM   #20
Thinks s/he gets paid by the post
wabmester's Avatar
 
Join Date: Dec 2003
Posts: 4,459
Re: Poll: surgery or cast?

Quote:
Originally Posted by marpea
I was told there would be less likelihood of osteo arthritis with surgery and so far no residual pain. Also I was probably in a cast a much shorter time which seems important to getting range of motion back.
Thnanks -- that's great to hear. I'm pretty convinced that surgery will produce the best outcome, but I still need to get past my fear of being sliced up and drilled into.
__________________

__________________
wabmester is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Personality Poll Martha Other topics 85 06-26-2010 06:33 AM
What do you drive? A car poll.... maddythebeagle FIRE and Money 80 09-21-2006 11:22 AM
Poll: Your Financial Support Of The Forum Danny Forum Admin 3 05-21-2006 12:44 PM
Poll #1 Early retirees and your Marriage ESRBob Life after FIRE 2 05-25-2005 07:50 PM

 

 
All times are GMT -6. The time now is 07:22 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.