Would you want your bone set perfectly after a break?

[skyblinking]

That's the question I got asked at A&E when I broke my arm by the ortho consultant- both bones broken and displaced and pulled back into place - or are you happy to make do? So now I wait for 9 days before getting it checked to see if I need a pin - to make it perfect.
Ortho-consultant discharged me with no pain relief and no advice on how to manage my plaster, the swelling etc - just wiggle your fingers.
I can't help but question the treatment I've had. I'm not 100% sure he could care less either way. Am I expecting too much from the NHS?

it doesn't sound like the question was put to you correctly.

My boyfriend badly broke his leg. He was told they could immediately cast it, let it heal, & he'd have one leg 2" shorter for life. Alternatively, there could be straightforward surgery to end up with (probably) equal length legs, but that had some risks, more to manage medically longer term -- he chose surgery, but it was right to give him choices.

No resetting is ever perfect, btw (says veteran of 3 broken arms).

Co-codamol is brill, maybe GP can prescribe you that over phone.

Did you ask what the pros, cons, risk, long term implications were to both options?

It is ok to give you an informed choice of treatments, but it shouldn't have been presented to you as "are you happy to make do". Some people don't want too much information, but both the consultant and the nurses who fitted ds's plasters usually ask is there anything you want to ask and if you do they will discuss in as much detail as you want.

No, the question was not put to me correctly - I have no faith he cared either way... a shame the consultant wasn't capable of better communication.

I'd want to know if I'd still have full use if I went down what seems to be the easier route. I'm more cautious though, as I have an Auntie who lost use of her lower arm, wrist and hand after just having a cast when she clearly needed more support.

@Blanketpolicy

Did you ask what the pros, cons, risk, long term implications were to both options?

It is ok to give you an informed choice of treatments, but it shouldn't have been presented to you as "are you happy to make do". Some people don't want too much information, but both the consultant and the nurses who fitted ds's plasters usually ask is there anything you want to ask and if you do they will discuss in as much detail as you want.

I was still coming down from the drug they gave me to pull my bones back into place - the ortho literally popped in to ask if I wanted a perfect fix or was I happy to make do, I told him I'd like it perfect - no discussion - I'm guessing that'll be for next week. Not very reassuring.

I think I need a second opinion - I'm so worried, they couldn't confirm that my thumb (scaphoid) wasn't damaged either - said that takes a few days too. I just don't trust them anymore but what else can you do?
The same hospital had my friend in for severe food poisoning for 3 days, discharged her, she came back in another 2 days before she convinced them to check her appendix - which had burst - the nhs just feels like it's coming apart at the seams.

I broke my ankle in three places I was 36 weeks pregnant they offered me the option of pinning and plating or putting a cast on once they had manipulated it into place. They said that if I chose the latter it wouldn't be as flexible and whilst I'd walk as normal I'd struggle running. I chose not to have it pinned.
It's about thirty years later, I've never had any problems walking and walk the dog 90 minutes a day, there isn't much movement in my ankle so steep inclines hurt walking down them, and I've got swelling and osteoarthritis that occasionally I take ibuprofen for but I've no regrets.

@skyblinking

No, the question was not put to me correctly - I have no faith he cared either way... a shame the consultant wasn't capable of better communication.

You can ask your own questions - if you didn't understand him, you should have told him that.

@Justkeeppedaling I get it - it was my fault for not having my thinking hat on after receiving a massive dose of PENTHROX - you're quite right - next time I break my arm I'll remember...to save the consultant from having to explain things properly.

@skyblinking why are you posting on here instead of phoning hospital / GP to ask more questions & sort out pain relief ?

It's not anyone else's fault that you didn't ask questions of you weren't sure or let yourself be discharged without any pain relief

I was dosed up on morphine & still perfectly able to ask questions

[quote ny20005]@skyblinking why are you posting on here instead of phoning hospital / GP to ask more questions & sort out pain relief ?

It's not anyone else's fault that you didn't ask questions of you weren't sure or let yourself be discharged without any pain relief

I was dosed up on morphine & still perfectly able to ask questions [/quote]
I'm impressed!

My MIL broke her wrist a few years ago and was just given a cast and her hand is now attached at slightly the wrong angle (though it works OK). :-(
Before this it had never occurred to me that treatment wouldn't be aimed at getting it back as close to perfect as possible by default!

Scaphoid break often doesn’t show initially as it’s a tiny bone. They usually plaster/splint then recheck. They don’t give much advice on swelling and pain as breaking arms etc is so common- just paracetamol and keep fingers moving. So that part is perfectly normal.
I’m not medical but broke my scaphoid and have parented broken limbs!

A few (very generalised) thoughts… perfect anatomical alignment doesn’t always mean restoration of perfect function (and isn’t always needed for restoration of function) and there is no operation that can’t make things worse. Scaphoid fractures don’t always appear obvious on day 1 and often need repeat imaging to diagnose/exclude. It is not unusual to reduce a fracture to a safe/acceptable position and review in fracture clinic. Some of those fractures do need further intervention, some don’t. If you were still recovering from sedation it wouldn’t have been the right time for the consultant to go into the minutiae and would not be considered informed consent for any sort of procedure. The fracture clinic is the normal place for further chat about the pros & cons of any further intervention. HTH. (COI: not an orthopod but have sat through maaaany hours of trauma meetings listening to the surgeons discussing the pros & cons).

@Greybeardy

A few (very generalised) thoughts… perfect anatomical alignment doesn’t always mean restoration of perfect function (and isn’t always needed for restoration of function) and there is no operation that can’t make things worse. Scaphoid fractures don’t always appear obvious on day 1 and often need repeat imaging to diagnose/exclude. It is not unusual to reduce a fracture to a safe/acceptable position and review in fracture clinic. Some of those fractures do need further intervention, some don’t. If you were still recovering from sedation it wouldn’t have been the right time for the consultant to go into the minutiae and would not be considered informed consent for any sort of procedure. The fracture clinic is the normal place for further chat about the pros & cons of any further intervention. HTH. (COI: not an orthopod but have sat through maaaany hours of trauma meetings listening to the surgeons discussing the pros & cons).

Very helpful and reassuring, thank you!

@hiredandsqueak

I broke my ankle in three places I was 36 weeks pregnant they offered me the option of pinning and plating or putting a cast on once they had manipulated it into place. They said that if I chose the latter it wouldn't be as flexible and whilst I'd walk as normal I'd struggle running. I chose not to have it pinned. It's about thirty years later, I've never had any problems walking and walk the dog 90 minutes a day, there isn't much movement in my ankle so steep inclines hurt walking down them, and I've got swelling and osteoarthritis that occasionally I take ibuprofen for but I've no regrets.

My SIL went for the pinning and plates option with her ankle. 10+ years on she is still on tramadol and has regular appointments to work out if removing the pins/plates might be better, but this will also be very invasive and high risk so she has put it off so far. She regrets going for pinning, but who knows what her long term prognosis would have been with out it.

There is no "perfect fix" treatment with broken bones and no way to guarantee the outcome, just options.

@WeAllHaveWings There is no "perfect fix" treatment with broken bones and no way to guarantee the outcome, just options. You tell that to the consultant - it wasn't me who introduced the word perfect!

Scaphoid is in the wrist but can affect the thumb and the fracture doesn't immediately show up well on an xray.

I've twice been plastered for suspect scaphoid fractures as a precaution. First time when they looked a week later the plaster came off, no fractured scaphoid. Second time it was fractured and I ended up with what was then an odd looking casing which was waterproof to take on holiday!

You definitely should ask for it to be perfect and get the pin. I'm surprised they asked if the scaphoid is involved. I was told my fracture was a sprain and didn't need an X-ray. I went back weeks later in agony and it was fractured right across the bone. I have since had 1 surgery and am awaiting another. I currently have no use of my thumb. I fractured my scaphoid on my dominant hand and can't do my job properly.

Because the bones can still move in first 3-10 days of recovery affter a break, "they" often wait a week before giving treatment. So they are right to be a bit vague about how perfect the treatment can get you back. It's good that you think about what you want, because surgery etc. can be unpleasant and barely worth it.

I dunno about scaphoid, but yeah, medical science has limits.

I would go for surgery

I'm so sorry you're dealing with this

I had two breaks and went private for both. I know I'm very lucky to have had the option. If you have the option, I'd definitely take it.

Id be very concerned. I had accidents at different times resulting in 1) broken arm and (2) broken ankle and foot

Broken arm was seen to privately but was back in 1980s when things were fine differently. I had a hanging cast that the weight of the cast pulled the bones into places with calcium layer forming to encase the shards. Was advised I would lost some usage of my arm and it may not be completely straight. Today would be addressed with surgery, pins and plate.

Foot and ankle was taken care of on nhs. I was told I had to have surgery within a certain time frame as healing starts. I broke it in a Wednesday and Monday was the last date they could do the surgery. I was on standby for the Saturday and Sunday if a theatre slot opened up.

For this reason, do not wait. See if you can get to a fracture clinic. Get a second opinion

Psi relief - I did not have pain relief before surgery. I did not have Pain relief fir the arm. Had to make due with ice paracetamol or ibruprofen.

When I had surgery, I was given cocodomol. However, I cannot take it because it makes you constipated and I have diverticular disease. I cannot be constipated. Be forewarned about cocodomol. GP gave me short term prescription for tramadol.

I have private as an option - I think I will get a second opinion - it's not the first time I've broken something unfortunately and my kids have broke 3 bones between them , I've never felt the need to question the standard of care, the surgeon was so off-hand - suggested I go wait in the waiting room for results of the x-ray while I was still recovering from sedation - the HCA told him they wren't busy and there was plenty of beds and no need to push me out of A&E said it would be better for me to be observed till dh arrived - he just shrugged and said whatever.

I hear you op. I'm currently in a wrist cast, it's rubbing inside and loose but fracture clinic won't see me as I have already had the cast replaced once.

The Hospital already missed the break on my first attendance as it "wasn't even sprained" and I was making a fuss, to just use it as normal as was fine. Good news is that I wouldn't even need a split as the nurse felt I would be dependant on it. I asked how she came to that conclusion, because I had been issued mobility aids by the Hospital for a neurological condition in the past (wheelchair and rollator) however I haven't used either for over 2 years so I'm obviously not dependant on them. However it was from a flare of one of the Neuro symptoms that was a factor in my falling over as you can't put weight on your leg when it's numb and dragging and it gave way and I put my hands out instinctively to save myself.

I lost total feeling in my fingers several days later due to compression of the nerves from the break and went back through minor injuries who poked needles into my fingers to check for feeling, when I opened my eyes I was wondering why they were bleeding. Plaster of Paris cast which fell off in my sleep a few days later, was now refereed to the fracture hub in the Hospital 40 miles away who recast it in fibreglass. Local hospital won't touch it now but it's moving around in the cast and causing pain but fracture clinic wont see it as my appointment isn't due till 3rd week of March and it was secure when I left there.

This is my second break in same wrist in under a year but the advice was just to be more careful and not fall over. I never would have thought of that. I'm not holding out a lot of hope for the wrist to be set properly.

You often can't diagnose a schaphoid # immediately you'll
need an x-ray in about 8 days . Orthopaedics is Imperfect is not without risks . Need an informed decision when the swelling settles.