Wrist Fracture treated with an External Fixator


"What to Expect When You're Expecting -- A Fixator"

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Wrist Fracture Outline

About five years ago I fell wham on the hardpack while snowboarding, and put out my hands to break my fall. My left wrist started to swell, so I figured it was sprained and went down to the lodge to put some ice on it. There my mom spied me with the ice, flipped out, and dragged me to a doctor. Good thing, since the x-rays revealed what the doctors call a compression fracture of the radius, otherwise known as a broken wrist (though I took to calling it a broken arm to make it seem more dramatic).

The doc decided that it was lined up pretty well already and we’d just cast it, but he warned me that I might never be a pizza flipper. After eight weeks in a cast and a bout of physical therapy, it was pretty darned near normal, but even now it still hurts when I lift heavy things palm up. So we need to add “furniture mover” to the list of verboten careers.

Call me weird, but it was kind of disappointing to have a door slammed shut so early in life, even if it was a pizza flipper door. So that’s why, when I broke my other arm (wrist) a couple of months ago (yeah, snowboarding), I was pretty psyched when my doc told me he was going to aim for perfection.
This time my wrist had a distinct S-curve to it when I arrived at the hospital. They had treated 400 wrist injuries there during the two-week Christmas period alone (!), so they were really prepared and efficient: a diagnosis (“Honey, your wrist is broken!”), a shot to numb it, some traction to straighten it, a splint to hold it, and there you go.

X-ray of Displaced Wrist Fracture

I was pretty psyched after all that because the bones in the x-rays looked A-OK to me. But the doc at home, a different doc this time, was cautious. And indeed x-rays taken five days after the fall showed the bones were moving. He recommended surgery for my “fracture of the distal radius” so we could ensure the bones healed in the proper position; it was my right wrist, he said, so he wanted to fix it as best as possible. Since then I’ve talked to people who did not have surgery and wished they did, so I am very grateful I found a doc who knew what to look for. His plan was to put in an external fixator, basically an adjustable bar held in place by two pins in the forearm and two pins in the hand, to keep the bone long and in-line while it healed. Then he’d take it out and after some physical therapy all should be back to normal. I checked out the doc and the procedure, and it all seemed on the up-and-up, so decided to go with it.

Surgery was kind of fun, actually. It looked just like on television, except the doctors wore these weird hats that gave it kind of a carnival atmosphere. The only decision I had to make was whether to get local or general anesthesia, and I opted for local so I could pay attention to what was going on and not have to feel all groggy when it was over. Everything went fine, though the anesthesiologist talked through most of the interesting parts and, worse, he talked about his skiing trips, which wasn’t exactly what I wanted to hear given my current predicament and the mounds of fluffy snow awaiting in the mountains. But I was what they call a captive audience! After about one or two hours we were done and my arm was all bundled up and a dead weight lying on my stomach.

X-ray after wrist fracture had been set with external fixator device in place

X-ray after wrist fracture had been set with external fixator device in place You have no idea how heavy your arm is until it’s completely numb. Or maybe it was the fixator and all the bandages, but it was pretty cumbersome and difficult to move around. So I hung out in a big chair, happily reading and missing a day of work, until the anesthesia wore off about eight hours later, when I had the distinct feeling that my arm was on fire. It was wild. I was dying to figure out exactly where the pins were, but I had no idea because the whole thing was blazing. The vicodin didn’t seem to make a difference, but it probably did, as I slept fine that night. My arm occasionally throbbed during the next couple of days, but it would almost always stop if I held it up, particularly if I lay down and elevated it. The hospital gives you a special pillow, a Carter pillow, that helps you sleep with your arm elevated, so I used that. The pillow didn’t have room for the pins, which hurt when they rested on the foam, but you can carve it out to make it more comfortable. (The pins stuck out from my arm about three inches!) So sleeping was okay. Walking-wise, it was generally uncomfortable having my arm hang at my side, because the pins in my hand, with all the fixator weight on them, would push downwards. So I got in the habit of walking with my arm up in the air. If you are lucky and have wise-cracking colleagues like I do, they may even start calling you Liberty (as in Statue Of).

Photo of external fixator device

After that first week, my arm didn’t hurt much. I was really careful with it, backing through doorways, trying to keep it up when possible, and trying not to bang it, in particular staying out of crowded places. It did hurt to rest it palm down on a flat surface, so I had pillows at work, at home, and in my car to rest it on. Once or twice it got achy, but all I needed to do was rest and elevate it, and it would be okay. My fingers were more problematic. They were very difficult to move in the beginning. The thumb and index finger were affected the most, but even the other fingers took two or three weeks to even begin to feel normal. By the time I got the fixator off six weeks later, those fingers were reasonably good, but my thumb and forefinger lacked strength and some flexibility. I couldn’t, for example, stretch an elastic band or open a pair of scissors. I think that was the main difference between the fixator and the cast – I don’t remember having such weak fingers when I had a cast. The cast was also more comfortable in some ways – it didn’t hurt to rest it on a table, for example. On the other hand it itched like crazy and even started to smell (yook), so overall I’m not sure which I prefer.

During the time I was “fixated”, I found there are very few things you absolutely cannot do with only one functioning hand. Everything’s a challenge in the beginning (tying shoes, washing contacts, buttering toast), but you figure out a way, finding new uses for your knees, elbows, and teeth. I also made a point of getting regular exercise so the rest of my body wouldn’t get all messed up just because of my arm. I used the time on the gym bike to work on strengthening my fingers and to stretch my shoulder some, which got kinked from sleeping in a weird way. The doc was very insistent about getting my fingers working early, since rehabbing my wrist was probably going to be hard enough.

After about six weeks they took out the fixator. No OR this time, just some allen wrenches and I don’t know what else. First they took the top bar off, then they took out the screws. It didn’t hurt at all – they had to kind of wrench the top bar, which was screwed on really tight, and then you just feel a slight tearing around the top of the pin holes when they take the screws out. They gave me a valium which I took, but I don’t know if that made a difference. The nurse claimed it did, since I was giggling, but I swear that wasn’t why :).

And that’s about it. It was great to be able to wear long sleeves again! My wrist was completely stiff that first day. It hurt to even try to hold it up in the air. The doc gave me a brace to wear, but I figured if I wore it my wrist would never get stronger, so I just carried it around with me. Two weeks later, my wrist can bend slightly, but there is no side-to-side motion and I can’t even begin to rotate it palm up. I start physical therapy soon, which will be great, and I’ve started swimming again (sort of), which should help. Maybe I’ll put an addendum to this when I get through; I’m hoping everything will be A-OK. In the meantime, don’t listen to that guy with the ACL tear who gave up skiing for shredding. Two boards are better than one. Trust me.

Link to ACL guy's Story