Distal radius Fracture (Broken wrist) ORIF

What is distal radius ORIF?

Radius is a larger forearm bone that connects hand and forearm through wrist joint. Though the wrist joint is made of 9 other bones, fractures in Distal (lower end, towards the wrist) of radius (arm bone) are very common. There are many variations in the fractures in the distal radius and majority of them could be treated non-operatively.   In selected cases open reduction and internal fixation of Distal Radius Fractures is performed. It is a surgical procedure most effective to treat fractures in distal radius. The main aim of the surgery is the realignment and stable fixation of the fractured ends of the radius bone during the process of healing.

 

What are the indications for the procedure?

  • Open fractures
  • Comminuted fractures
  • Unstable wrist
  • Displaced intraarticular fractures (>2 mm)
  • Dorsal angulation of distal end of radius (>5 or >20 degrees)
  • Shortening of radius bone (>5 mm)
  • Associated ulna fractures
  • Complex extra-articular fractures
  • Palmar tilt more than 10 degree

 

What are the benefits?

Distal radius ORIF is beneficial in

  • Restore anatomy of wrist
  • Relief of pain
  • Union of all the bone parts
  • Relief of deformity
  • Regaining the range of motion and optimal function
  • Re-establish biomechanics and kinematics of wrist joint

 

What are the risks?

  • Carpal tunnel syndrome (median nerve neuropathy, 1-30%)
  • EPL rupture
  • Malunion
  • Non-union
  • Stiffness in the wrist
  • Superficial or deep infections (1-2% which may raise to >5 % in diabetics)
  • Post-traumatic radiocarpal arthritis
  • Hardware complications- screw penetration into the joint
  • Radiocarpal arthrosis
  • Injury to ulnar nerve and radial sensory nerve
  • Complex regional pain syndrome

 

 How should I prepare for the procedure?

  • Before surgery, your surgeon will investigate your general condition through certain tests such as blood tests, electrocardiogram or chest X-ray to rule out any health risks. This helps to rule out any possible risks of anaesthesia and surgery such as cardiac problems, bleeding, infection, etc.
  • X-ray of your wrist is taken to know the extent of the fracture. You are also examined for the chances of carpal tunnel syndrome before surgery. If there are symptoms of CTS, your surgeon will discuss with you about the need for carpal tunnel release along with Distal Radius ORIF
  • It is advisable to inform your surgeon about any medications or supplements you are taking. He may ask you to stop them before the surgery as they could complicate the operation.
  • If you are a smoker, you should stop smoking at least 48 hours before the operation. This is necessary as smoking can risk you of chest troubles or sensitivity of lungs towards anaesthetic. Besides smoking after surgery could delay wound healing, increases risk of infection and could even prevent fracture healing.
  • Any infection in the body for which you are taking antibiotics should be cleared up before the operation. Putting a metal work in your body when there is pre-existing infection, increases the risk of bone infection.
  • You should also stop eating or drinking 8 hours before the operation.
  • Positive attitude towards the operation and your condition are necessary for the success of the surgery. This will help you for better health benefits and faster recovery.

 

How is it performed?

  • You are admitted to the hospital and the operation is usually performed as a day case.
  • The operation is performed under general anaesthesia or local anaesthesia (Block). In general anaesthesia, the patient does not feel anything and sleeps throughout the operation. In local anaesthesia, the patient remains awake during the operation, but he cannot feel whatever is happening in the surgical area. Your anaesthetist can select a combination of both local and general anaesthetic.
  • Positioning- the patient is positioned in the supine position and hand is centred on the hand table.
  • A tourniquet is tied around your upper arm to reduce blood loss during surgery.
  • Procedure– once anaesthesia is given to the patient, antibiotics are also given to him to prevent any infection during and after the operation. In open fractures, the soft tissues and bone that are exposed, so they are cleaned thoroughly. A cut or incision is made in the affected site and the subcutaneous fat and muscles are moved aside in a gentle manner to look into the bone. The bone fragments are repositioned to their normal position. This procedure is called open reduction. Then, the bone fragments are fixed with the help of plates, pins or screws so that they remain in the proper position while healing process. This process is called internal fixation. In some cases, the fracture is reduced and held with pins or pins connected to a rod (external fixator). In cases of multiple fractures, bone substitutes are used to have faster healing and to fill the gap. The muscles and subcutaneous fat are then closed. The skin is closed with the help of absorbable sutures.
  • The operation takes 1-2 hours to end. Most patients are discharged on the same day.

 

 What happens after surgery?

  • The local anaesthetic wears off in 4-10 hrs after surgery; patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours from there. This way most of our patients report little or any pain.
  • Your wrist is rested in a half cast for 2 weeks to protect it from injury and allow proper healing.
  • You should keep your arm elevated (above the level of your heart) most of the times as it prevents swelling. Besides keep moving your fingers, elbow and shoulder.
  • Before discharge, your physiotherapist will teach you gentle exercises of the hand, wrist, elbow and shoulder that you can start soon after the operation from the first day.
  • The patient is reviewed in clinic around 2 weeks following the operation for wound check and physiotherapy.
  • Following ORIF with plates and screw, usually the plaster is changed to splint and hand therapy commenced
  • If the fracture is fixed with pins, that has to stay for 6 weeks and removed in the clinic after check x-rays
  • The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
  • You will be guided by your surgeon and hand therapists based on radiographic (X-ray) and clinical union of the fracture. In majority of the cases, you could start a gentle range of movement (ROM) exercises at 2 weeks and progress to more strenuous activities (swimming, driving, lightweights in gym etc) around six weeks. It is advisable to avoid contact sports or any injury to the affected area for 3 months. The duration may increase or decrease based on the personality of fracture, quality of bone and method of fixation.

Distal radius ORIF_1

  1. 57 year old plumber fell off from a ladder (20 feet) and sustained a complex fracture to his distal radius and ulna
  2. The fractures were fixed with plates and screws and he recovered full function back in his hand and wrist in three months

 Distal radius ORIF_2

80 year old lad had a fall on an outstretched hand and broke her wrist. This was fixed with plates and screws. She returned to her pre-injury level of activities three months after surgery.

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