My 75-year-old father had a bad break in his left wrist that just hasn't healed right. I suspect they should have done surgery instead of just putting a cast on it. Should I say something? Is there some other treatment that might fix the problem?
Wrist fractures in older adults are both common and problematic. Selecting the best treatment for each individual isn't always a cut-and-dry affair. Patient preferences, type of insurance coverage, severity of the fracture, quality of bone, and even geographical location can impact treatment methods. If the fracture is stable (bone is broken but ends are not separated), then a cast or airsplint is often the treatment of choice. Osteoporosis (brittle) bones, displaced (separated) fractures, and fractures with several (or many) bone fragments may require some additional care. In such cases, surgery to reduce (line the bones back up) the fracture and hold it in place may be required. This type of surgery is called open reduction and internal fixation (ORIF). It sounds simple enough but there are many different ways to accomplish the task. Once again, the surgeon is back to deciding what will be best for that patient. Should the volar locking plate system be used? Or would an external fixation device provide a better outcome for this patient? There are multiple fixation systems to choose from including screws, wires, plates, and rods. And each of those can be placed in different ways. Having said all that, let us throw one more thing into the mix. How the bone fracture heals (and looks on X-ray) or from the outside doesn't always translate into poor motion, strength, or function. In other words, it could be just a visual deformity that doesn't impair the use of that wrist or hand. Your father can always seek the opinion of his surgeon about this situation. But if he is not distressed by how it looks and the hand works just fine, there may be nothing needed in the way of additional treatment.