Read through the treatments of Casting, Volar Plating and External Fixation, and learn how the approaches vary from MICRONAIL® Fixation.
Most broken wrists are considered simple breaks and treated non-surgically with a plaster or fiberglass cast. Casts, however, are not always a reliable treatment because the bones can still shift after the swelling around that area begins to decrease, even with the cast on the patient's arm. After a few days, the extra room inside the cast now, can allow the bones to shift and not heal properly. When the cast is removed, the wrist may look deformed and surgery must be scheduled to align the bones correctly.
Summary: Studies have shown that as many as 70% of wrist fractures treated by casting alone, redisplace at five weeks. That means that the bones can shift underneath the cast, causing healing to either take longer – or causing the bones to heal incorrectly. (Source: JBJS, March 2002).
More complex fractures require surgery, in which either internal metal plates or external fixation devices are used. Unfortunately, both of these can limit wrist movement and may be uncomfortable to the patient.
Volar Plating is used when the wrist bones are broken in 2 or 3 pieces. This involves placing a metal plate on top of the broken wrist bone and holding the fragments together with that plate and screws. The placement of the screws is critical. They must be long enough to secure the broken pieces, but short enough not to protrude through the backside of the bone. This could cause tendon irritation or rupture.
This surgical procedure also requires a larger incision (typically a 5-6 inch incision) and may not provide the desired level of flexibility / wrist function as quickly as the MICRONAIL® Fixation implant can.
When there are multiple fragments of bone involved with a complex wrist break and external fixation device may be used. External fixation, or ex-fix as it is commonly called, normally involves a straight metal bar with a minimum of four screws that secure it into the broken bone, through the patient's skin. The surgeon makes 4 incisions; two in the base of the second finger and two midway down the forearm. Once the screws are drilled into the bone, the metal bar will remain in place for 6-8 weeks.
A disadvantage to external fixation is a condition called "Pin Tract (SP) Infection". This infection may be caused by bacteria growth in the open incision where the screws petrude through the skin.
Unfortunately, external fixation can also limit wrist movement and may be uncomfortable to the patient. If applied too long it can cause stiffness which may require a longer rehabilitation treatment with a hand therapist.
Summary: Forty-six articles reporting the outcomes of current internal and external fixation treatments for unstable distal radius fractures were statistically analyzed. The authors concluded they "did not detect clinically or statistically significant differences in pooled grip strength, wrist range of motion, radiographic alignment, pain and physician-rated outcomes." (Source: Journal of Hand Surgery, November 2005)
A better treatment option is now available to patients. The MICRONAIL® Fixation implant, Wright's new, minimally-invasive implant, offers significant potential benefits over traditional external casting and surgical techniques including:
- a less-invasive surgical technique with smaller incisions
- faster, less painful recovery; faster return to wrist motion / function
- less post-operative irritation
- better grip strength
- and less scarring
It is the first and only implant that is implanted completely within the wrist bone, therefore eliminating soft tissue irritation.
As you have read, there are multiple treatment options if you (or a loved one) have a broken wrist. It is important to discuss them with your doctor as only you, and your doctor, can decide the appropriate course of treatment for your individual situation.