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Wrist Surgery Served Up on New Plates

Wrist fractures can be very difficult to treat. Sometimes the bone breaks into several pieces. Sometimes the bone moves apart after it breaks. Getting the bone back together and lined up properly requires complicated surgery. Even with surgery, the two sides of the wrist joint don't always match up. This can lead to pain, swelling, and loss of wrist motion.

Doctors in Switzerland have noticed fewer problems when surgery is done from the palm side of the wrist. With this method, called the palmar approach, it's easier to move tendons out of the way. There is also more space for the plate that holds the bones together. This method of surgery is used when the broken bone moves toward the palm side of the wrist. Movement of bone after a break is called displacement.

When the wrist bone breaks, the bone can move in the opposite direction, toward the back of the wrist. Bone displacement toward the back of the hand is much more difficult to repair. Damage to the tendons, nerves, and blood vessels is more common when the back of the wrist has to be opened up.

These doctors tried the palmar approach for wrist fractures with bone moving toward the back of the hand. A special plate with pegs and screws was designed just for this surgery. It was tested in a laboratory and found to be three times stronger than other plates already in use.

The results of this experiment were very good. The break healed faster, and there were fewer steps in surgery. There was less tendon disruption, and the joint matched up better. Faster return to normal wrist strength and motion is possible with this new approach.

References: Jorge L. Orbay, MD, et al. Volar Fixation for Dorsally Displaced Fractures of the Distal Radius: A Preliminary Report. In The Journal of Hand Surgery. March 2002. Vol. 27A. No. 2. Pp. 205-215.

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