Impairment in the functionality of the wrist because of any broken bones in it requires immediate medical attention by the wrist surgeon else it has the potential to incur permanent damage.

Rationale:

When any of the ten bones in the wrist break, it is medically referred to as a wrist fracture. Injury caused to the wrist by traumatic fall on an outstretched hand or accident or weak and arthritic bones that are easily susceptible to break are common causes of wrist fractures which result in intense pain and swelling with the wrist becoming deformed. The patient is unable to move the wrist and seeks immediate treatment. It is thus essential that wrist fractures be accurately diagnosed and effectively treated to prevent long term loss in functional movements of the wrist.

Approach Considerations:

Wrist Fractures may either be displaced or nondisplaced i.e. they may either be stable or unstable. The wrist surgeon undertakes these fractures by reduction and fixation technique but fractures that break into many fragments i.e. comminuted fractures require surgical intervention as they are severe in nature and the end of the bones cannot be held together by metal hardware.

Treatment of wrist fractures depend on factors such as-

• - The age, health and activity level of the patient
• - The nature and severity of the fracture
• - Presence of associated injuries

Techniques of Treatment:

Treatment techniques are taken up by reduction, realignment and fixation, depending on their nature and severity, by the wrist surgeon.

The various techniques which act as a tool for the wrist surgeon to fix wrist fractures are-

Casting / Splinting: Casting or Splinting are techniques that include covering of the fractured bone with two layers of bandage that are soft on the inner and hard on the outer base. This protective covering is placed on the wrist after realigning the bones as stabilizers and immobilizers to enable proper healing of the bones.

Closed / Open Reduction: Under closed reduction technique the broken bones are realigned physically with manipulation without exposing the bone surface. The wrist is either placed under cast or splint after reduction or further held together with fixators such as pins, screws or K-wires. Under open reduction technique, bones are reduced and realigned after making an incision on the wrist and exposing the bone surface. The wrist surgeon then holds the end of bones together with metal fixators such as pins, rods, plates, screws to enable proper healing. After open or closed reduction the wrist is placed in a cast or splint for a definite period of time.

Metal Hardware Fixation Technique: When the fractures are severe they alone cannot be fixed by reduction techniques. They require the support of fixators to hold the end of broken bones together so that the bones can join adequately and function as prior to the fracture. The fixators that are used by the wrist surgeon internally or externally are-

Plates - type of internal splint which hold bones together by being attached to them with screws.

Screws- the most used implant for internal fixation that come in various sizes for different bones. They are either used as an individual implant or as support with plates, rods or nails.

Nails / Rods- used as implant to fix long bones. They are inserted through the hollow centre of the bone and then held with screws on both ends to stabilize it.

Wire / Pins- used as internal fixators for very small bones that cannot be held together by screws.

Pre / Post Fixation:

After the evaluation of the nature and severity of the fracture the wrist surgeon has an in depth discussion with the patient where the patient is informed about the exact technique that will be most applicable to his case. After collecting information regarding any allergy or reaction to any chemical composition or any other such point that may hinder the procedure of fixation, the fixation is gone ahead with.

After the fixation, medications and rehabilitation protocol to be followed by the patient to facilitate quick recovery are prescribed by the wrist surgeon. Instructions which include activities that need to be avoided by the patient and guidelines to help the patient take care of the fractured hand fixation are also handed out. The hand is placed in a sling or brace to immobilize it for a definite period of time and a follow up visit to closely monitor the progress is scheduled.

Complications:

As with any treatment technique, fixation technique also has its limitations. They may be prone to some risks that may vary from delay in union (longer time to heal), non- union (not heal at all), mal -union (heal with a visible deformity) to infection in the fixators or the incisions made to insert them.

Benefits:

Fixation by metal hardware with open or closed reduction is the most accurate technique to treat severe fractures. Reduction technique involves reducing and realigning the bones, fixators enable these reduced bones to be held together in their anatomical position so that they do not easily get displaced and enable healing.

Rehabilitation:

When the wrist is placed under splint or cast for a definite period of time to immobilize it, the result is stiffness and numbness when they are removed. To enable the patient to restore mobility and reduce stiffness a well formulated rehabilitative program is an essential prerequisite. By various protocols inclusive of massage, gentle exercises and other personally suited methods, a therapist helps the patient to gradually work on those bones and not only learn pain management but cope with activities and slowly get back their wrist in form.

More about Wrist Surgeon:

Dr. Vikas Gupta is an acclaimed professional in the field of upper extremity. Based at Max Healthcare presently as the head of hand and shoulder division, Dr. Gupta strives to deliver treatment for each and every debilitation in the upper extremity that result from traumatic injuries or congenital and degenerative diseases. Dr. Gupta has been awarded with prestigious honors for his exemplary and significant contribution to the field after being in the profession for more than 25 years and more than 6000 surgical releases. His forte of deliverance over the years have been AIIMS, Fortis, Medanta- the Medicity and presently Max Healthcare. As an MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and post graduate studies from Germany and USA, Dr. Gupta has been introductory to many international and painless techniques and emerged as highly influential role model for his peers and interns. With an extremely calm demeanor and compassionate approach he makes patients seek his medical advice and with deftness in surgical skills and accurate diagnosis he has proven to be an outstanding specialist. Max Healthcare, his present forte of deliverance is a super specialty hospital that believes in proving the best, most cost effective and painless techniques to their patients through international machines and team of ingenious professionals.