Houston Methodist. Leading Medicine

Wrist FAQ

Question:

My 84-year-old mother broke her wrist over the weekend. The surgeon is planning to put some kind of new fangled plate inside her arm, which, of course means surgery. I can't see doing surgery on someone this old who is already fragile enough to break her arm. Am I wrong in my thinking about this?

Answer:

For years and years, the main treatment approach for anyone over 65 with a wrist fracture was immobilization. Plaster casting was used for a long time. Then lighter materials were developed. And now sometimes, a removable rigid splint-like cast is used to allow for periods out of the cast such as when bathing. Immobilization of any kind is acceptable when the break is simple, nondisplaced, and without fragments of bone. In other words, the fracture is stable. It's a different story when the bone is broken into many tiny pieces. More rigid fixation with plates, screws, pins, or wires inside the arm may be needed. Sometimes external fixation (pins through the bones with connecting rods outside the arm) is required. Over time what the surgeons have found is that casting an unstable wrist fracture often results in the collapse of the bones. This means a loss of function for the patient. And that could be devastating for a senior who is trying to maintain his or her independence as long as possible. They also observed that the time it takes to heal a stable wrist fracture in a cast (four to six weeks) often leads to a stiff wrist and subsequent loss of motion and function. That's why more surgeons are turning to surgery to repair unstable fractures. Newer technology and techniques have made it possible to speed the rate of recovery with surgical fixation. The goal is to preserve the elderly's ability to live independently, something most seniors are very interested in. Kevin C. Chung, MD, MS, et al. Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly. In Journal of Bone and Joint Surgery. August 2009. Vol. 91-A. No. 8. Pp.1868-1873.

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