Numbness in fingers after distal radius fracture surgery

A distal radius fracture is a specific term for a type of wrist fracture. This is the most common fracture of the wrist. The fracture can be simple with just two fragments or may shatter into many pieces (“comminuted”). Most fractures are “closed” (no break in the skin), but they can also be “open” (a break in the skin). Fractures may be even more complex if they involve the major wrist joint (an “intra-articular” fracture). Fractures may occur as part of a more complex injury where there has been damage to other tissues such as tendons, nerves and blood vessels.

What may indicate a distal radius fracture?

A wrist fracture is almost always the result of some type of trauma, most commonly a fall onto an outstretched hand. Weak bones (like those with osteoporosis) will break more easily.

When the wrist is broken, there is usually a great deal of pain and swelling. This pain and swelling can make it hard to move or use the hand and wrist, but some people can still move or use the hand or wrist even if there is a broken bone. The wrist may appear deformed because the bones are out of place. Depending on the position of the break, you may feel numbness or tingling in your fingers.  

How is a distal radius fracture diagnosed?

The diagnosis of a distal radius fracture is made by reviewing your medical history, a physical examination, and X-rays. Additional tests, such as a CT scan, may be required to get high level detail of the fracture and fracture fragments to determine the type of treatment that is necessary.

How is a distal radius fracture treated?

Generally speaking, the treatment will be guided by a few main factors:

1. How “bad” the fracture is – whether it is displaced, unstable, or open.
2. The “you” factors – your age, hobbies, functional demands, activities, your health, and what you do for work

If you suffer a “displaced” distal radius fracture, the first step may be to “reduce” or “set” the fracture. This may be done in the ER by an ER physician, or by one of our hand surgery specialists.  If the fracture is stable, a cast may be used to hold a fracture that has been set. Other fractures may benefit from surgery to put the broken bones back together and hold them in correct place. In some cases, a well performed operation can get you back to your normal activities faster and with better results than if you have a cast alone.

Will I need therapy following distal radius fracture treatment?

Regardless of whether the fracture is fixed or not, you will require some hand therapy to get the motion of your wrist back. The timing and duration of therapy will depend on whether or not you have surgery and how stable your fracture is. Hand therapy is very helpful to recover motion, strength and function.

Symptoms

When you have a distal radius fracture, you will almost always have a history of a fall or some other kind of trauma. You will usually have pain and swelling in the forearm or wrist. You may have a deformity in the shape of the wrist if the fracture is bad enough. The presence of bruising (black and blue discoloration) is common. See your doctor if you have enough pain in your arm to stop you from using it normally. You may want to go directly to an orthopaedist (bone doctor), who can usually take an X-ray right in the office and tell you what is going on. If your doctor's office is closed, the injury is not very painful and the wrist is not deformed, you can usually wait until the next day. Go to the emergency room if the injury is very painful, the wrist is deformed, you have numbness, or your fingers are not pink. You may want to protect the wrist with a splint and apply ice to the wrist and elevate it until you get to the doctor's office.

Treatment

There are many treatment choices. Your orthopaedic surgeon will describe what options are right for you. The choice depends on many factors, such as the nature of your fracture, your age and activity level, and your surgeon's personal preferences. The following is a general discussion of the possible options, just so you have a better idea of what your orthopaedic surgeon might recommend for you.

One choice is to leave the bone the way it is, if the bone is in a pretty good position. Your doctor may apply a plaster cast until the bone heals. Or if the position (alignment) of your bone is not good and likely to limit the future use of your arm, your orthopaedic surgeon may suggest correcting the deformity (the medical term for correcting the deformed bone is reduction). If the bone is straightened out (reduced) without cutting into the skin (incision), this is called a closed reduction. After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days, to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down, and changed two or three weeks later as the swelling goes down more and the cast gets loose. X-rays are taken, depending on the nature of the facture, either at weekly intervals for three weeks and then at six weeks (if the fracture was reduced or felt to be unstable), or less often if the fracture was not reduced and thought to be stable. The cast is removed about six weeks after the fracture happened. At that point, physical therapy is often started to help improve motion and function of the injured wrist.

If your orthopaedic surgeon feels that the position of the bone is not acceptable for the future function of your arm, and that it cannot be corrected or kept corrected in a cast, he or she may recommend an operation. There are many ways of performing surgery, including reducing the fracture in the operating room without making an incision (closed reduction), or by making an incision (open reduction) to improve the alignment of the bone. In the operating room, your orthopaedic surgeon may choose to hold the bone in the correct position with only a cast, or by inserting metal (usually stainless steel or titanium) pins, a plate and screws, an external fixator, or any combination of these techniques.

Recovery

This is a very simple question. Unfortunately it does not have a simple answer. The kinds of distal radius fractures are so varied and the treatment options are so broad that it is hard to describe what to expect. Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed. One combination is ibuprofen (sold as a generic or under the brand names Motrin® or Advil®) plus acetaminophen (sold under the brand name Tylenol®, and also as a generic, often marked on the box "non-aspirin pain reliever"). The combination of both ibuprofen plus acetaminophen is much more effective than either one alone (the medical term for this is synergistic). If pain is severe, patients may need to take a prescription strength medication, often a narcotic, for a few days. Discuss these options with your doctor.

Casts and splints must be kept dry, so use a plastic bag over your arm while you are showering. If you do get it wet, it will not dry very easily (you can try to use a hair dryer on the cool setting). There are no real "waterproof" casts, but there are some options available that have their pluses and minuses. Discuss this with your doctor.

Most surgical incisions must be kept clean and dry for five days or until the sutures (stitches) are removed, whichever occurs later.

Everyone wants to know, "Can I return to all my former activities, and when?" This is a great question that also seems rather simple and straightforward, but the answer is complex. Most patients do return to all their former activities, but what will happen in your case depends on the nature of your injury, the kind of treatment you and your surgeon decide upon, and how your body responds to the treatment. You will need to discuss your case with your doctor for the specifics of your case, but some generalizations can be made.

Most patients have their cast taken off at about six weeks.

Most patients will start physical therapy, if their doctor feels it is needed, within a few days to weeks after surgery, or right after the last cast is taken off.

Most patients will be able to resume light activities such as swimming or working out the lower body in the gym within a month or two after the cast is taken off, or after surgery.

Most patients can resume vigorous physical activities, such as skiing or football, between three and six months after the injury.

Almost all patients will have some stiffness in the wrist, which will generally diminish in the month or two after the cast is taken off or after surgery, and will continue to improve for at least two years.

You should expect your recovery to take at least a year. You will still feel some pain with vigorous activities for about that long. Some residual stiffness or ache is to be expected for two years or possibly permanently, especially for high energy injuries (such as motorcycle crashes, etc.), in patients over 50, or in patients who have some osteoarthritis. However, the good news is that the stiffness is usually minor and may not affect the overall function of the arm.

Remember, these are general guidelines and may not apply to you and your fracture. Ask your doctor for specifics in your case. Your doctor knows that returning to activities is important to you.

Finally, osteoporosis is a factor in as many as 250,000 wrist fractures. It has been suggested that people who suffer a wrist fracture may need to be screened for osteoporosis, especially if they have other risk factors. Ask your doctor if you need to be screened or treated for osteoporosis.

Information provided by the American Society for Surgery of the Hand.

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