A Solution for a Common Orthopedic Injury – Distal Radius Fracture Repair  for Wrist Fractures

Along with cold weather, snow, and ice, winter in the Northeast means an increase in distal radius (wrist) fractures, most of which occur from landing on an outstretched hand after  a slip and fall. These fractures result in pain, limited range of motion, and decreased wrist function. For patients with a fracture that is significantly displaced, surgical intervention may be recommended.

Our orthopedic surgeon, Dr. Meyer, specializes in treating upper extremity injuries (fingers, hand, wrist, and elbow), and understands the tremendous impact that wrist fractures can have on patients’ lives. In patients who are candidates for surgery, he has seen excellent outcomes from Distal Radius Fracture ORIF (open reduction and internal fixation, which means fixing the bone in its native position with a plate and screws). 

Below, we asked Dr. Meyer some questions about the procedure.

Q: In your own words, how does this procedure benefit your patients?

A: Distal radius fractures are the most common fracture of the upper extremity (shoulder, elbow, wrist, and hand). The radius bone is part of the forearm, and the distal (end-portion) of the radius supports the bones of the wrist. Certain distal radius fractures are stable and will heal well with a period of immobilization in a cast. Other distal radius fractures are unstable and often benefit from surgery to align the fracture pieces in a more anatomic position. 

When surgery is performed, a combination of a plate and small screws are used to hold the bones in the optimal position. Surgery for displaced distal radius fractures have been shown to lead to excellent outcomes, including near-complete return of motion and grip strength and very low rates of persistent pain and disability. The majority of patients sustaining these injuries are able to return to their jobs and hobbies without limitation.

Q: Who is a good candidate for this procedure? 

A: Anyone who sustains a broken wrist should be evaluated with a physical exam and a set of x-rays. A wide range of both patient-related factors (age, medical history, functional demands from jobs/hobbies, smoking status, etc.) and injury-related factors (mechanism of injury, fracture alignment/displacement, etc) are used to help guide the decision between treating a wrist fracture with a cast (no surgery) versus performing surgical fixation.

Q: Where do you perform this procedure? 

A: I perform surgical fixation of distal radius fractures at the New England Center for Orthopedic Surgery (NECOS), Portsmouth Regional Hospital, and York Hospital.

Q: Tell us about a recent success story.  

A: A 65 year old woman presented to my office after slipping on black ice and injuring her wrist. She had a displaced distal radius fracture that significantly limited her wrist motion. She is an elementary school teacher, and her two biggest goals were to optimize her long-term wrist function and to return to activity quickly. We discussed the treatment options, and she chose surgery in order to accelerate her rehabilitation, minimize her time in a cast, and give herself the best chance for healing her wrist injury in an anatomic position. 

We fixed her wrist with a plate and screws. The surgery took a little over an hour and she was back to work the same week. Within two weeks, she was out of her splint and working on gentle wrist range of motion exercises. She is an avid pianist, and found that playing piano helped to improve her wrist and finger motion in the early post-operative period. Six weeks after surgery, we started gentle strengthening. By the 2.5 month-mark, she was cleared for full strengthening and return to all activities. Now, she is back to all school-related activities and does not feel limited at all by her wrist. 

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them? 

A: These fractures occur most commonly after a slip and fall onto an outstretched hand. Here in the Seacoast, we see a large upstick in the number of patients sustaining distal radius fractures during the wintertime. Whether it is slipping on ice or falling while skiing or skating, these injuries can unfortunately happen at any time. The best way to treat a wrist fracture is to not have one! So, my best advice is to make sure to tread carefully when walking, skating, and skiing. Furthermore, many patients in their 60’s and 70’s have osteoporosis (thin bones that are more prone to fracture). With several months of cold and cloudy weather in the Seacoast, many of us also have low calcium and Vitamin D levels. I would encourage patients to discuss their bone density and calcium and Vitamin D levels with their primary care physicians in order to make sure their bone health is optimized to start off the new year.

If you’ve suffered a wrist fracture, it’s important to consult with an orthopedic specialist as soon as possible. Dr. Meyer’s treatment philosophy centers on listening to patients and working together to find solutions, both surgical and non-surgical, that help them resume a pain-free active lifestyle. Contact us to schedule an appointment with Dr. Meyer today.

Is Pain in Your Thumb Holding You Back?

CMC Arthroplasty As A Solution For Thumb Pain

If you’re experiencing pain and stiffness at the base of your thumb, you might be dealing with CMC (carpometacarpal) arthritis. But don’t worry – you’re not alone. There are effective treatment options available for this common thumb condition that can provide much-needed pain relief and restore motion.

What are the symptoms of CMC arthritis?

Common symptoms include pain at the base of the thumb, especially during pinch and grip activities. The joint also may become swollen and tender to the touch. Typically, CMC arthritis decreases mobility in the thumb, and weakness may develop that makes it difficult to grasp objects.

What causes CMC arthritis?

CMC arthritis is a degenerative condition, often attributed to the aging process. Other contributing factors can include:

  • Repetitive use: activities that require repetitive thumb movements can accelerate joint wear and tear.
  • Trauma: a previous thumb injury can increase the risk of developing CMC arthritis.
  • Genetics: genetic history may predispose some people to joint degeneration.
  • Inflammatory conditions: certain immune or inflammatory conditions can contribute to CMC arthritis.

Atlantic Orthopaedics’ hand surgeon Dr. Meyer answers some common questions about CMC Arthroplasty, a life-changing procedure for patients suffering from advanced thumb arthritis.

In your own words, how does this procedure benefit your patients?
Arthritis at the base of the thumb (CMC arthritis) is a common source of pain and disability for adults, affecting one in three women and one in eight men over the course of their lifetime. A variety of treatment options exist, starting with conservative management (bracing, therapy, anti-inflammatories, corticosteroid injections) and progressing to surgery. For advanced thumb CMC arthritis that does not respond to the above treatments, CMC arthroplasty can provide lasting pain relief and improvement in thumb strength and motion.

There are a variety of surgical techniques for CMC arthroplasty. Most involve the removal of the painful, arthritic bone at the base of the thumb (trapezium) and use of a nearby tendon to stabilize the thumb in its native position. Recent innovations in the field of hand surgery have allowed for the use of a non-absorbable suture instead of a patient’s own tendon to maintain the thumb’s resting position. This procedure, termed a suture-button suspensionplasty, avoids complications from harvesting nearby tendons and allows for accelerated rehabilitation and recovery after surgery. While most other techniques require between four to six weeks of immobilization in a cast, I allow my patients to start gentle motion after their first post-operative visit (approximately 10 days after surgery) when using this technique.  

Who is a good candidate for this procedure?
Thumb CMC arthritis can affect anyone, but it becomes more prevalent with older age. This procedure is typically indicated for middle-age and elderly adults who have painful arthritis at the base of their thumb that limits their daily activities.

Where do you perform this procedure ?
I perform thumb CMC arthroplasty procedures at NECOS, Portsmouth Regional Hospital, and York Hospital. 

Do you have a recent patient success story you can share?
A 65-year-old retired professional pianist presented to the office with painful thumb CMC arthritis that failed to improve with bracing and steroid injections. Alleviating pain and preserving thumb motion were her biggest priorities. Due to her activity level, we elected to perform a CMC arthroplasty using the suture-button suspensionplasty technique.

Her surgery and post-operative course both progressed very smoothly. She was seen at her first post-operative visit and transitioned to a removable brace that allowed for gentle motion. At six weeks, she began gentle strengthening under the guidance of our occupational therapy team. At three months, she was cleared to return to full activity. She is back to playing piano and feels that her motion is even better than before surgery because she is no longer limited by pain. We were thrilled to help her get back to one of her favorite activities and to enable her to keep teaching other aspiring pianists.   Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
Thumb CMC arthroplasty yields excellent results, but it is not the only treatment recommendation for patients with thumb CMC arthritis. There are a variety of non-surgical and surgical treatments that can help with pain at the base of the thumb prior to considering a CMC arthroplasty. Every patient evaluation begins with a thorough clinical history, physical examination, and radiographs (x-rays) of the hand. From there, I work with each patient to understand their goals before we collectively decide on an appropriate treatment plan moving forward.

CMC arthritis can be a debilitating condition, but there is help available. For many patients, CMC Arthroplasty has proven to be an effective way to alleviate pain and restore quality of life. If you’re suffering from pain and limited function in your thumb, schedule a consultation with Dr. Meyer to discuss whether CMC Arthroplasty may be right for you.

Atlantic Orthopaedics & Sports Medicine