Fixing wrist fractures without a cast

Jan 17 2008

It is prime season for wrist fractures. Ice and snow covered streets are the main culprits as victims instinctively reach out their hands to break a fall.

According to Mark Cohen, an orthopedic surgeon at Rush University Medical Center who specializes in hand, wrist and elbow surgery, it is not unusual for him to treat three or four broken wrists a week in the winter, and often more than four in a single day after an ice storm.

Fortunately, advancements in technology and new techniques are allowing wrist fracture patients to get back in the swing of things faster than ever before, and in many cases they can resume their normal day to day activities even while their fractures are healing.

In the past, it was not unusual for a patient with a broken wrist to wear a cast for six to eight weeks or even worse, an external metal frame drilled into the hand and forearm bones. Today, broken wrists can not only be fixed through minimally invasive surgical techniques but patients can typically use their hand and wrist within days of the fracture.

This evolution of care is thanks to smaller implants known as locking plates. Newer plates designed specifically for the wrist eliminate the need for larger incisions and allow early return to function.

“The new plates are much more stable than older models. The screws holding the plate to the bone now lock into the plate creating a strong bond to hold the bone in place,” said Cohen .

These newer smaller plates, one of which Cohen has helped develop, allow surgeons to make a much smaller incision, less than 2 ½ inches long, on the palm side of the wrist. Patients wear a dressing to keep the wound clean and a splint for three to five days. Therapy begins just days after the surgery.

“It used to take six to nine months to fully recover from a fractured wrist. With this new plate technology, smaller incisions, and early rehabilitation, some patients tell me they feel normal within two months,” said Cohen.

“In the past a wrist fracture was a terrible inconvenience. Patients had to wear a restrictive cast or external frame for six to eight weeks. They couldn't write, type, drive, or even shower,” said Cohen. “With the new plating systems, patients are starting therapy within days of the surgery and most return to work within a week.”

Broken wrists are more common in women than men. The incidence increases rapidly after menopause with the highest percentage of wrist fractures in women between the ages of 60 to 69 years. Osteoporosis, or age related bone loss, is mostly to blame. Cohen says the best prevention is eating right, exercise, and vitamin and mineral supplements to stave off osteoporosis; and of course using extra caution when navigating through icy streets and sidewalks.

Rush University Medical Center offers the only dedicated center for hand, elbow and shoulder care in Illinois. The center's team of experts includes surgeons with extensive experience in microsurgery and reconstructive surgery, as well as occupational therapists and physical therapists specializing in rehabilitation of the hand and upper extremities. Ranked eighth in the country by U.S.News & World Report, the orthopedics program at Rush is a leader in research and new therapies that benefit patient today.