Broken wrist - advice needed!

[BeHangryUser]

I broke my wrist last week and it was displaced. It was reduced at the hospital and initially looked fine, but a follow-up X-ray one week later showed that the bone had moved again, so I now need surgery.
I’ve been given two options: K-wires with a cast for 6 weeks, or a plate and screws (which would be permanent), with a cast for 2 weeks followed by a splint for a few more weeks.
I think I would prefer the K-wires as the are less invasive but than again require a longer time in a cast, while the plate allows for quicker recovery. I’m really unsure what the best option is and feel quite worried about the whole situation.
Has anyone been in a similar situation? I’d really appreciate hearing your experiences or perspectives.

My DS had similar a few years ago. He wasn’t offered a choice - it was just accepted that he would be getting a plate and screws. The recovery after surgery was rough - that first 3/4 days were very hard in particular. Once he got his cast off he was still in a fair amount of pain and his movement and strength were very limited. However, he was given 8 weeks of physio beginning about 7/8 week post surgery and it made a huge difference. He was signed off from physio with a glowing report as his strength and movement were so good. He was back rock climbing about 4 months after the surgery which was no mean feat. Within about 6 months he was completely back to full strength and he’s never had any other side effects from the surgery or plate/screws.

Thank you so much for your reply. It’s actually really reassuring to hear a positive outcome. I’m sorry your son had such a tough time in those first few days, that part definitely worries me, but it’s encouraging to know things improved so much with physio.
I think part of my hesitation with the plate and screws is the idea of something permanent, but hearing that he’s had no longterm issues is really helpful!

I understand the fear! It was presented as a done deal to him so there was no choice to make, which I’m glad about. He was warned that sometimes the screws can go too far through the bone, and can then be visible/cause pain in the upper side of the forearm. That was really the only thing that worried him. It never happened though.

He had a nerve blocker after the surgery so was able to sleep ok that first night, but once the nerve blocker wore off after 24hrs he was in intense pain. He also had a bad reaction to some of the pain meds they gave him, so by day 3 he was on paracetamol only as that was all his body could handle. In all his 21 years, I have never seen him so ill or in so much pain. He was grey and looked like he was on drugs. That definitely made things much worse for him as he really needed strong pain meds but couldn’t tolerate them.

The physio was key for him - do check with the hospital what they will offer you.

He genuinely has had no long term issues though, works out a lot and does a sport which is very intense on the wrist absolutely fine. He doesn’t even beep when going through the airport scanners.

I was supposed to have the plate but when I woke up I had the wires! Initially cast was to be removed after four weeks, which they did but it was a bit tender so they put another cast for one more week. I had only broken my radius. I don't know if that was a factor. I am really glad I had the wires in the end. About 18 months later, write is fine and no plate!

After care was pretty rubbish though so I had to look up exercises after cast came off online. It took a while for mobility to come back.

@NellyNoMates That must have been really scary for both of you. Seeing him in that much pain and not being able to tolerate the meds sounds awful. I think that’s one of the bits that worries me most too. I’m hardly in any pain now, so the thought of going back to square one after the surgery (or even worse for a few days) is pretty daunting.😥I actually can’t wait for it to be over so I can start physio and get on with the recovery!

@Faffette Thank you for your message. Wow, what a surprise that must have been for you! That’s great to hear that it all worked out. I’m hoping for the same outcome. Did the wires bother you at all under the cast? The doctor mentioned possible infections but reassured me that they are rare.

They didn't bother me no. What bothered me was not knowing where they were, or even how many. Also at that point I thought I had broken both bones. (Like I said after care wasn't great) The most pain I had was around the ulnar. The muscles and ligaments. I thought the pain was the wires but it wasn't. So no they didn't really hurt. I did wonder about infection as well but it was fine.

If given a choice now, I would definitely go for the wires again. But ask more questions!

It's a bit odd that they're offering you a choice....

There are some fracture configurations where a plate is absolutely necessary... Your surgeon should know if this is one of those.

The DRAAFT trial, a few years ago directly compared plates vs wires in fractures where there wasn't a clear reason to choose one over the other, and found wires were cheaper, quicker surgery with fewer complications and the outcomes were no worse.

Personally I think you need to have another chat with your surgeon, or maybe seek a second opinion.

There are other specific reasons you might choose one over the other, for example I couldn't work wearing a cast, so might choose a plate in order to return to work earlier, that may be very important depending on your sick pay, and how much earnings you would lose, or it might be completely irrelevant.

I broke my wrist about 15 years ago and had k wires popped in under a local block (non UK country). I had a cast for a few weeks and they recommended a general anaesthetic to remove them in the UK (I did ask just for them to pull them out without but they werent keen....)

I had the usual weak wrist/hand when they removed the cast but it healed beautifully and I have had no issues since. Infact if I didnt have the small scars, i wouldnt know which wrist had broken

Edited to add: It was sore for a 2 weeks when post op and I had the cast on but after that it was fine and i was using my hand to do stuff and look after 3 small children.

@BeHangryUser about five years ago I had a nasty displaced distal radius fracture and I think the ulna and another little bone broke too. My lower arm was a very funny shape. That part was excrutiating.

It was reduced in A&E and a few days later it was pinned and plated. I didn't have a choice.

I have no recollection of any acute pain after pinning and plating and took cocodamol 30/500s for the first couple of days. I also was working the following day gently using my fingers on the keyboard.

The cast was on for a fortnight and was then replaced with a velcro splint that I could take off in the shower. I think I was driving about a week after that (ahem) but it was fine in an automatic. Whilst I was cautious I kept my fingers moving.

Fortunately it was my left arm and I could continue to do most things. I think the splint was off after about four weeks and I mobilised gently and as much as possible. Physio started about a week after that and I was rigorous with the exercises and ordered weights and putty. I was signed off after the next visit and had pretty much full strength back. I purposefully made myself lift coffee mugs and a half filled kettle.

Very occasionally it feels a tiny bit stiff and I have a very fine barely noticeable scar. The plate and pins have never bothered me and I have never given them a second thought.

I was 60 when I did it and just remember the shambles in A&E and a spectacularly rude F2 there.

The only thing that seemed remarkable was the severe bruising. I expected my fingers to be bruised but elbow to mid upper arm was significantly and deeply bruised. It cleared up quickly though. There was some slight swelling for a long time and itnwas about 6/7 months before I could wear my bracelet watch again. My wedding ring had to be cut off and the repair cost more than the ring more than 30 years previously. The ring may bear more scars than me!

Except for when it happened I have little recollection of much pain.