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Ask Dr. Rick – September 2011 – Wrist Fractures

September 8, 2011

The topic of distal radius or fractures of the wrist is very popular right now. Distal radius fractures are very common, and the distal radius and the radius are the most commonly broken bones in the arm. Distal radius fractures are most commonly caused when someone falls on an outstretched hand, which can occur in a car accident, a bike accident or simply by falling. What happened is that when the athlete puts their hand out, their body weight is dissipated through the distal end of the bone.

This type of fracture can also occur with an extension mechanism, as if somebody was running into their hand or falling onto their hand. The fractures have many names, the most common of which is a Colles’ fracture. In this situation, the fracture creates an extension of the wrist, which is also called a dorsiflexion.

A fracture of the distal radius causes immediate pain, swelling, tenderness, bruising and is generally extremely uncomfortable. These fractures can vary from nondisplaced fractures that are not detectable on an x-ray to an obvious deformity of the radius. If a fracture does not show up on an x-ray, a CT scan or an MRI is normally ordered to determine if there are portions of the bone that are broken.

The treatment for displaced wrist fractures where the bones are not well-aligned can either be closed reduction, which means to push the fracture into place, or closed reduction, where the doctor will either pin or put a cast on the fracture. Another treatment is an open reduction, which means making an incision and then either putting a plate or pins across the fracture. Nonsurgical treatment can include wearing a splint or a cast, and the decision as to how to treat the fracture depends on the alignment of the fracture, how many pieces the fracture is in and if the fracture is a complete fracture, an incomplete fracture, a radiographically obvious fracture or a subradiographic fracture.

Fractures generally take four to six weeks to heal. It will most likely cause some element of pain for one to two weeks, and after immobilization from a distal radius fracture, a short course of physical therapy is recommended. If the fracture is not completely healed when activity is resumed, pain generally occurs. The chances of refracture are low, but it is still higher than an initial fracture and can result in a longer healing period.

In general, this is a very common injury, and athletes heal very well after appropriate care and physical therapy.

Ask Dr. Rick

“Dr. Rick, I have been hearing significant popping in my hip for about seven months. I am a dancer, and this has been very difficult in terms of my dancing. Do you have any suggestions?” – Linda T., Town & Country

Linda, Popping in the hip is a common complaint among dancers, and there are a number of causes. The most common cause is a tear in the acetabular labrum, which is the cartilage in the hip, and this can occur from the excessive activities that dancing requires. Other common causes include snapping of the iliopsoas tendon, which is one of the tendons in the hip, or the snapping or sliding of the iliotibial band over the greater trochanter, which is on the outside of the hip. If you have had this for a number of months, you need to be evaluated by your physician. Good luck. Please get this treated sooner rather than later.

“Dr. Rick, I very much enjoy your articles, and I have a quick question: I have been taking over-the-counter ibuprofen for approximately one month. It seems that every time I take the ibuprofen, I get sick to my stomach. I have been taking four ibuprofen three times a day, which is the recommended dose, and I wonder if this is what is causing my stomach pain? Thank you very much.” – J.T., University City

J.T., Post anti-inflammatory nausea is extremely common, and almost 80 percent of people do experience significant problems with nonsteroidal anti-inflammatory drugs. Significant problems would include GI upset, possible GI bleeding or gastrointestinal bleeding and nausea. There are a number of possibilities to combat this. One would be to take a coated nonsteroidal anti-inflammatory such as Arthrotec. Another is to take an over-the-counter stomach medicine with your anti-inflammatory; this would be over-the-counter Prilosec, cimetidine, etc. If you are having abdominal pain, you a

September Medical Tip: Make sure that your mattress is firm and that you are not waking up with back pain. This type of pain is commonly caused by a mattress that is too soft.

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