Houston Methodist. Leading Medicine

Wrist FAQ

Question:

Mother fell down during the holiday and broke her wrist (a Colles' type fracture). I was amazed that the surgeon gave HER the choice of treatment: surgery or no-surgery. I guess I thought surgeons made all those decisions based on their training and experience. Why confuse an elderly widow with more on her plate than she can handle by asking her to decide what to do?

Answer:

That is a very good question. Your mother's situation represents a shift in thinking toward more patient participation in many different medical decisions (evaluation and treatment). Part of this has come about because of the Baby Boomers (adults born between 1946 and 1964) who have now reached senior citizen status. As a group, they are more independent, more involved, and more demanding of their rights in many areas, including medical. Patient satisfaction has become an outcome measurement of results. That means the surgeon's satisfaction with how something looks on X-ray after treatment is not the only way results are measured. Treatment ideas for Colles' wrist fractures (radial bone is broken and displaced -- meaning the end of the bones have separated) have ranged from the early days of Dr. Colles (even if the break doesn't heal perfectly, the arm will function fine) to efforts started during the 1950s to "fix" the deformity and make it look straight again. The 1950s through the early 1990s found surgeons reducing the fracture as much as possible thinking that would ensure a more functional outcome. But today, after many trials of different surgical methods of repair and restoration, it looks like the evidence supports Dr. Colles' ideas after all. The extra cost of surgery and risk of complications may not be worth it -- studies are showing that surgery doesn't always yield a better result. It comes down to this one thing: having a perfectly placed wrist fracture (as seen on X-rays) isn't necessary to regain full function and use of the wrist. And, in fact, this type of anatomic alignment isn't linked with loss of wrist and hand function in the older adult. Studies comparing results between surgical repair and nonoperative treatment show equal results six and 12 months after the injury. And, patients treated with surgery suffer more complications more often that are worse than in the nonoperative groups studied. Patients treated conservatively report high levels of satisfaction with nonoperative care. So now, instead of performing surgery right away to reset the bones and hold the two ends together with a metal plate and screws or pins, surgeons discuss all the pros and cons of both treatment approaches (surgical versus nonsurgical). Patients are given full disclosure based on current evidence when making a treatment decision between surgery and conservative care for displaced distal radial wrist fractures. It is still a joint decision between surgeon and patient. The surgeon will recognize when a patient is unable to participate fully and then help guide the patient toward the best choice for his or her own circumstances. All factors and variables are taken into consideration including the patient's age, general health, presence of other diseases or problems, severity of the fracture, and the patient's activity level and personal goals. As a family, you have some opportunities to express your cares and concerns as well. Charles S. Day, MD, MBA, and Michael C. Daly, MSc. Management of Geriatric Distal Radius Fractures. In The Journal of Hand Surgery. December 2012. Vol. 37A. No. 12. Pp. 2619-2622.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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