Fractured Radius - Surgery and a plate or cast?

Discussion in 'Face Plant' started by OutRecording, Jun 1, 2016.

  1. OutRecording

    OutRecording Been here awhile

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    Went down a couple days ago (in full gear) and fractured my radius near the wrist. The emergency room orthopedic said it needs reduction and I can choose either a cast or surgery with plate/screws. The plate would be removed in about a year.

    He says either choice the end result would be the same: full use of wrist and can continue aggressive off-roading. The only issue he said, would be a higher chance of osteoarthritis when I'm older (I'm 40 now) if I choose the cast option.

    I'm going to talk with the orthopedic surgeon tomorrow to make a decision. Surgery would be this Friday.

    I'm not hot on the idea of surgery. Mainly because I'll be put under. But the (emergency room) doc felt surgery is the better option.

    What I'm wondering is if anyone has had a similar experience? How is riding with a plate and screws? Upsides/downsides? Any advice from personal experience as a rider?

    Thanks
    #1
  2. Tallbastid

    Tallbastid Let's get tropical

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    I feel I can comment, though my experience has been with a super bum ankle. I broke it in a moto crash in high school, and have had two very bad sprains since and numerous rolls. It is now permanently swollen, and I've lost a bit of mobility in it. I cannot get the ankle in a snowboard boot (yet), after my last bad sprain, 2 years ago.

    Anyways, doc recommends going in to have it opened up and bolted back together properly. Apparently lots of soft tissue/ligament damage and improper bone growth has really screwed it up. However, having known 4 people who went in for very similar surgeries, not a single one of them has recommended having it done. In fact, they all regret it entirely and say it's only made things worse. Keep in mind these are 4 people, of different athletic ability, with different doctors. I've promised myself to do anything I can to stay out of surgery if I can help it. If I were you, not knowing every single detail, I would go the cast route and avoid potential of further damage to your wrist. Then again, I'm an idiot. :D
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  3. OutRecording

    OutRecording Been here awhile

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    Thanks for taking the time to reply. Definitely understand any advice is "internet advice" as they say. :) But getting a fellow rider's perspective is good stuff. These docs don't ride and probably aren't thinking from that angle with their advice. (And they prob shouldn't be! Hehe)

    One thing I've read, with plates and screws there's a chance if you go down in a similar fashion the bone may break at the point of one of the screws, making matters that much worse.

    The doc made it sound like having the plate would add protection. But I wonder if that's really true.

    Main point is, I wanna be back in the saddle ASAP. But the thought of osteoarthritis in the wrist ain't pretty either.

    I'll probably flip a coin. ;)
    #3
  4. OutRecording

    OutRecording Been here awhile

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    While I'm here, why not share the story how I went down. Pretty stupid really...and a cautionary tale of sorts.

    In short, be wary of your new tire(s).

    I mounted up a new front (DOT) knobby and went for a ride the next day. We had a discussion recently in the klx thread about being careful with new tires the first 20 miles or so. With that fresh in my mind, I had planned to take it easy til I hit the trails. Made it about 50 yards from my house...

    Made a right turn at a stoplight, nice and slow and easy. Front tire just washed out. Can't remember how I landed. But knew my wrist was screwed up the moment I stood up.

    That's it. Pretty boring tale! To add insult to injury, my wife had to come help me push the bike back home. My left hand was useless.

    So yeah, go scuff up your tires some before heading out! Lesson (painfully) learned... :(
    #4
  5. SnipTheDog

    SnipTheDog Been here awhile

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    Another note is that most insurances will pay to put the plate in, but won't pay to pull the plate out. Pulling the plate out in some cases is considered an "elective" surgery.
    #5
  6. OutRecording

    OutRecording Been here awhile

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    Thanks for noting that. Luckily I'm in Taiwan. They have national healthcare here which would cover it if the doc deems necessary. And how underpaid they are here from what I've read, they'll surely want to do it. (Which half worries me about the suggestion for surgery in the first place. They'll make a lot more for a surgery over a cast...) But don't get me wrong. Top notch medical care here if you can get past being part of the "herd".
    #6
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  7. FredBGG

    FredBGG Long timer

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    My son. Broke his tibia near his ankle. Local docs recommended a simple cast. I sent x-ray to 2 docs in the big city. Private docs.
    Both recommended surgery. Later managed to reach my Dad. Spinal doctor. HE told me to go with the local doctors.
    It was a ski resort and he said they know what they are doing up there.

    Went with the cast. Results were perfect.

    Surgery with plates and screws in your wrist is a risky business. Loads of tendons and ligaments. Two bouts of total being put under.

    If they said you can get a cast, I'd go for a cast. Just be very diligent about your therapy afterwards. Very important part of getting better.

    Good luck!
    #7
  8. L.B.S.

    L.B.S. Long timer

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    Relatively simple break, I would say cast. Having had a few wrist/arm surgeries, (although some necessary unfortunately) if I can possibly avoid it, I sure try to lol!

    Sometimes the problem with casts, is the atrophy which occurs through lengthier immobility. Step up your physio asap and work through it, should be fine. Surgery can often allow faster short term results, but in my mind there's no free lunch. There is always a trade off of risks lurking somewhere along the line.

    Any way you can get a second opinion from another specialist?

    Best wishes for a perfect recovery no matter which option chosen!
    #8
  9. south

    south Been here awhile

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    I've gone both routes: broke my right arm just above the wrist years ago, before plating was fashionable, and it was casted; broke the left in a crash a little over a year ago, and it was (permanently) plated. IMO, the biggest factor to consider is the doctor performing the work. When I broke my right wrist, they knocked me out with a general anesthetic to set it and put my arm in a cast up to mid-bicep with my elbow bent at 90*. About 3-4 weeks later, after taking some follow-up x-rays, it was determined that the angle of the healing bone was less than satisfactory (doc didn't set it right, or the intern/nurse didn't get the cast tight enough, or whatever--makes no practical difference, doesn't change the end result), and I was put under again so they could re-break and re-set the bone and put it back in a new cast. Needless to say, by the time my arm was (finally) free of a cast, it had atrophied significantly and it took a number of weeks before I could merely even fully straighten my elbow.

    The left wrist was plated by an orthopedic surgeon with literally decades of experience who was a former hospital chief of staff for whom the procedure was virtually as common and simple as tying his shoelaces. For the first week or so after the plating, the arm was just in a forearm splint wrapped with an Ace bandage, then, once the stitches were removed, I was in a forearm cast for 4 weeks or so.

    While there may be a mental element at work, nevertheless, at every point in the healing process, the plated wrist felt more stable and secure, and I was absolutely making more use out of the hand right from the outset. Now, there came a point with the casted arm where I had similar use, but that wasn't until well over a month in. As you've been told, short-term recovery was much faster with the plated wrist, although I think in terms of long-term recovery the two options are somewhat closer, albeit still perhaps favoring the plate/screws. Granted, I'm only 14 months out with the plated wrist, and/but the doc's claim of "in a couple months, it'll be like it never happened" notwithstanding, the plated wrist does still exhibit some aches and twinges under duress, and until recently, I would wake up every morning with some passing numbness in the 3 outer fingers of the hand. That said, 95+% of my day I don't even think about it, only at times of some shock loading or significant twisting, and avoiding those scenarios (for now) becomes second nature. However, it seems to be on a recovery trajectory which will not include the modest aches of the casted wrist 2-3 years in and possibly the occasional minor aches literally decades after the break. And, in any event, no issues or concerns whatsoever with the wrist(s) as far as riding a motorcycle goes.

    Anyway, either way you go, I'm absolutely sure it won't prevent you from riding as you wish after some months of healing, but I'm pretty sure you're going to be aware that you broke your wrist for a least a few years to come.
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  10. baldman1

    baldman1 Been here awhile

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    I had the same injury to my left wrist in 2011 went down on the freeway at 80pmh. I chose the screws and plate, the hardware is still in, no plans on getting them taken out. I healed right up and have full range of motion, no issues at all from it, insurance picked up the entire bill. And I was over 50 years old when it happened so if I healed up from it you should too.
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  11. OutRecording

    OutRecording Been here awhile

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    Thanks for your experiences everyone.

    I talked to the surgeon this morning and he felt the break was low enough that arthritis wouldn't be an issue. He said what the other doc said, end result would be the same, just take a bit longer to get there. And really it was up to me what to do. I opted for the cast.

    They gave me a shot for the pain but it must have been water for all it did! The reduction was...less than nice, let's just say. :) Got a cast and X-ray looks good. Will go back Tuesday for another X-ray. Wish me luck!
    #11
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  12. rboett

    rboett posser noob 205

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    Good Luck!
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  13. John2453

    John2453 Discovering northern VA and the surrounding areas

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    I was told that if you break a bone w screws in it, it will shatter/shred and not be able to be repaired afterwards. Are there any orthopaedic surgeons on this list who can comment on whether this is true?
    #13
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  14. baldman1

    baldman1 Been here awhile

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    Well I have a bunch of screws, rods and plates all over inside my bones, so far I haven't shatter / shredded anything.
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  15. OutRecording

    OutRecording Been here awhile

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    Thought I would follow up a bit in case anyone is in a similar situation in the future.

    Went to the hospital today to check how things are healing. X-ray showed the bone moved a few millimeters. :( He said it would eventually heal fine like that but might have some movement problems and a slight bend to the wrist. His suggestion is surgery.

    Looks like my gamble didn't pay off. Oh well. Surgery tomorrow afternoon. I highly suggest if you will ever be put under that you don't Google "anesthesia complications". Furthermore, don't read anything with the words "anesthesia awareness"! Haha...the Internet can be brutal sometimes! :)
    #15
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  16. skyking42

    skyking42 n00b

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    I had both wrist broken at the same time. They were bad as the doc had seen. After surgery my screws and metal looked similar baldman1. The day after I felt much better and way less pain. That was in 2004 and still have screws and metal. I am now 68 and wrist work good enough.
    #16
  17. grommets

    grommets Don't get hurt

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    If it needed reduction it was not a simple break. I just saw this but would have recommended plate. I have a plate in my collarbone, which was broken into 3 pieces. Even with the X-rays right there, the ortho doc said I could do without the surgery and it would eventually heal up. That made no sense to me so I had the surgery. Afterward he said it was good that I did because it was worse than he thought. No shit. It was in 3 pieces. I could tell that it would never heal right just by looking at it. And feeling the inner part pushing up against my skin making a bump about 3/4" high. To me it was totally obvious.

    I think a lot of people are scared of surgery and going under, so docs have a tendency to offer alternatives to that. For me the option of dealing with a screwed up bone forever is way worse than taking a nap. No comparison.

    Yeah bones heal. Trees heal in the forest too, all by themselves, but lots of them are pretty messed up looking.
    #17
  18. Rover31

    Rover31 Jedi

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    Not true, we repair those kinds of things. Just take more work and more hardware.
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  19. Rover31

    Rover31 Jedi

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    Good luck I think you will do great complications happen but are very rare.
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  20. OutRecording

    OutRecording Been here awhile

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    Almost three weeks since the surgery. Well...I'm typing this with both hands. Surgery went off without a hitch. Only "complication" was the pain afterwards. They had given me some morphine before I woke up apparently. I didn't notice! They gave me a second dose not long after waking after I complained a lot. I also barely noticed. :( An hour later they felt it safe enough to give me a THIRD shot...and again I barely noticed any difference. Finally the old man in the hospital room next to me mentioned something I could pay extra for that works great. We asked and they gave it to me. It worked....but only after two hours.

    I've always had some resistance to pain relief medicine. Novocaine....need three shots at least. Had a finger surgery with local anesthesia when I was young....two shots. I totally felt them slicing into me after the first shot. All the pain meds they gave me after this broken bone did little. It took me chewing up three Ultracet before I could feel most the pain go away. Anyway...I think the morphine they were giving me must have been crap. It's paid for by the government, so....

    I go in tomorrow for a follow up. Everything is feeling good and I'm getting mobility back in my fingers. Can't wait to start the wrist therapy.

    On a side note, I pulled my clutch and throttle cables one-handed. And yesterday installed a brake snake I had been putting off. Guess I'm not doing too bad if I can work a drill. :)
    #20
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