Of fracture and old age

*disclaimer: in case you’re reading this - *not a reference *every case is different for each person *probably not that reliable *just a personal account of an experience: have you encountered a similar experience?

Case of a fall:

She fell on the ground, face down but was able to  protect herself (a reflex) from the fall by using her hand as a support. Think of this. You’re falling down and as you fall, your wrist is extended or your palm faces the ground and this small of your body is the first to touch the ground. All the weight of your body would be concentrated and carried only by your wrist and hand! Ouch!

Here’s what she felt after. She can move her legs, neck, shoulders, elbows and fingers freely and without pain - meaning they’re alright. The problem arised on the wrist part of her left hand. Her kind of fall is typically called “fall on outstretched hand” . The thumb side of the wrist, a part of her lower arm and the lower part of her hand was swelled. It was also painful as she reported and she is not able to move it in certain positions also due to pain. Pain was also felt when the area was touched or moved by another person

She had an x-ray the next day and it was confirmed that she had a wrist fracture (a common type of fracture).

The orthopedic doctor explained that in her case, there were chipping of a part of a bone resulting to many bone fragments. This means it’s not a simple case of just realigning the bones into its perfect normal condition.

Suggestions was either to do a surgical procedure (it requires anaestesia and confinement!) called ‘closed reduction’ wherein the bones will be realigned using metal pins (internal fixators) or to just put the wrist in a cast.

[Closed reduction is done to complicated fractures (like the case mentioned) much encouraged to younger persons and those who do heavy work because they tend to use their hands a lot. The more normal realignment was also significant for aesthetic purposes.]

[Casting, is usually only advised to those with less complicated fractures (one or two fragments) because it can easily be realigned]

Factors to consider are that  the patient was already of old age, who doesn’t do any housework anymore and usually only do self-care activities with supervision and assistance (especially in walking, stairclimbing). In addition, the patient also has other concommitant conditions  including diabetes, hypertension, and history of mild strokes. This has a big impact on the procedure that would be performed.

The intervention:

The human body has a mechanism that automatically heals itself in time (that’s why there’s a joke that doctors only job is  to psychologize patients). For this case, as mentioned by the doctor, in two months, the fracture would heal by itself and the pain would be gone. However this is accompanied by a deformity and limitation of movement of the fractured site (the main joints and probably the surrounding joints). This is way medical intervention and rehabilitation is need. The part needs to function to the fullest despite the disruption of its normal mechanism.

For the patient, the casting was chosen. Why?

…. Because the patient, doesn’t do any heavywork. In fact, she only does self-care activities and is even given assistance to the more challenging or risky tasks like walking and stairclimbing.

… But the heavier reason is that doing a surgical procedure to her would be a complicated one because of her age, and her other conditions ( just think of the complications of diabetes).

… The surgical procedure would still need a lot of tests,  and would be more painful and stressful for her and her family).

… The casting is an easy procedure, done on the clinic, on the day of consultation (upon examination of the x-ray). No pain, done only for a couple of minutes and no stress at all.

The cast is pretty amazing. I was thinking that  plaster of paris will be used but surprise! The doctor was just putting protective stocking and then a bandage* which is  green and rubber like when you look at it which turned out to be a fiber glass. Wow. It’s a bit more expensive than the cement but it is more comfortable for the patient because of its light weight and quick application (applied similarly to bandage). And its fiber glass!?!

Everyone happy after. Doctor check-up next week. Same time, same day.

Quick info on wrist fractures:
http://orthopedics.about.com/cs/upperfx/a/wristfracture.htm