The radius, or ulna is the larger of the two bones of the forearm, and is the most commonly broken bone in the arm. The distal end is the end of the bone nearest the wrist. The majority of distal radius/ulna fractures can be treated nonsurgically through use of a cast. Some fractures of the radius and ulna cannot be treated with a cast alone, when the fragmented parts of the bone are extremely displaced. In those cases, surgery may be required, which begins by making an incision over the fracture site. The bones are then held in place by either metal pins, plates and screws, or an external fixator. The initial wound is then sutured closed. A second surgery may be required to remove the means of fixation.
Who is a candidate?
Candidates have a broken distal radius/ulna whose displacement is so severe that nonsurgical treatment is insufficient for recovery and healing.
Who is not a candidate?
Most patients with a broken distal radius/ulna do not require surgical treatment.
Prior to undergoing distal radius/ulna fracture repair, an examination to diagnose the broken bone in order to determine if surgery is necessary should be performed. Before surgery, you should inform your orthopedic surgeon of any medications or supplements you take, and comply with certain general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You may need to stop taking blood thinner medication (e.g. Warfarin). You will likely be asked to stop eating or drinking the night before the surgery.
Immediately after the procedure, you will likely be in a moderate amount of pain and be required to wear a cast for up to 6 weeks. Casts may need to be changed in order to accommodate decreased swelling. Follow your orthopedic surgeon’s postoperative instructions and attend any follow-up visits, which can then confirm proper positioning and normal healing of the distal radius/ulna. Full recovery can take up to 1 year including occasional pain from more vigorous activity, but stiffness in the wrist may persist for up to 2 years as the bone continues to heal. A physical therapy regimen may be recommended depending on the severity of the case. Most patients can resume light exercise activities 1-2 months after surgery and begin more rigorous exercise 3-6 months after injury.
As with any surgery, there are risks of complications related to infection, damage to nerves and blood vessels, bleeding and blood clots, or adverse reactions to anesthesia. However, incidences of these complications are extremely rare. Complications specific to clavicle fracture repair include nonunion (failure of the broken collarbone to heal), which occurs in about 15% of cases. The hardware added to the bone may also cause irritation and may require surgical removal later on.
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