Houston Methodist. Leading Medicine

Wrist FAQ

Question:

We were visiting friends in Canada when I fell and broke my wrist. The bottom of the radius was fractured. I'm 72 years old, so I thought they would just slap a cast on it and send me home to the States for the rest of my treatment. Instead, they did surgery to reset the bone properly and then put a cast on my arm and referred me back to my own physician. Is that what would have happened stateside?

Answer:

Whether here in the United States or to the north in our neighbor Canada's care, surgeons, patients, and family members usually work together to decide when an older adult with a distal radial (wrist) fracture is going to need surgery or not. Studies show that this type of fracture can be treated conservatively (nonoperatively). Results are often the same as if it were surgically repaired. Given the likelihood that older adults have additional health concerns (e.g., diabetes, heart disease, high blood pressure), having a nonoperative approach available with positive outcomes is good news. In a recent study, surgeons from the New York University Hospital for Joint Diseases focused on treatment for patients who were at least 65 years old and who had suffered the same type of wrist fracture you had. The average age of their groups was in the mid-70s. The goal was to compare results in patients with a distal radial fracture treated with cast immobilization to results for patients with the same diagnosis who were treated surgically. The results were measured (before and after treatment) in several different ways. X-rays were taken. A special test of function was given called the Disabilities of the Arm, Shoulder, and Hand (DASH). Grip strength and wrist motion were measured and recorded. Pain intensity was recorded at regular intervals (at two, six, 12, 24, and 52 weeks after treatment was started). In the end, the differences between the two groups were negligible. In other words, the differences in motion, pain, function, and strength were so small, there was no difference. Complications (e.g., nerve compression, tenosynovitis, stiffness, wrist pain) were equal between the two groups. Carpal tunnel syndrome was more of a problem in the group treated without surgery but the symptoms went away and were not permanent. Scores for the DASH test were basically the same for patients in both groups each time they were tested. It's likely that the protocol for deciding how to treat your fracture would be the same whether you were in Canada or in the U.S. Surgeons evaluate each patient individually taking all factors into consideration. They know that operating to restore normal wrist and forearm anatomy in distal radial fractures is not always necessary to get good results. Patient goals and level of activity are sometimes deciding factors. Less active, lower-demand patients may be treated with cast immobilization rather than surgery. K. A. Egol, MD, et al. Distal Radial Fractures in the Elderly: Operative Compared with Nonoperative Treatment. In The Journal of Bone and Joint Surgery. August 2010. Vol. 92-A. No. 9. Pp. 1851-1857.

*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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