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Musculoskeletal Services

Fractured Wrist (Internal Fixation)


IntroductionShow [+]Hide [-]

This information has been designed to give you and your family a basic understanding of what internal fixation of a fractured wrist involves and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions which the doctors, nurses, physiotherapists and occupational therapists will only be too happy to answer.

Why is the operation necessary?

Your wrist joint is like a hinge, it allows you to bend or straighten your hand. In a healthy wrist joint this movement is smooth and pain free. When the joint becomes damaged due to injury the wrist becomes swollen and painful with restricted movements.

Wrist fractures are very common. Not all fractures are easily treated with the application of a plaster cast therefore in many cases internal fixation is required. The most common forms of internal fixation used are screws, plates and wires, however your consultant will discuss with you the most appropriate form of fixation for your type of fracture.

Before the operationShow [+]Hide [-]

You will be admitted to the ward from the Accident and Emergency Department or Fracture Clinic. The nursing staff will meet you and explain the layout of the ward, and introduce you to your named nurse. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor will see you and arrange for your pre-operation tests. These are usually an examination, an X-ray and blood tests.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have.

The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent. The anaesthetist will discuss the type of anaesthetic best suited to you but usually the procedure is performed under general anaesthetic. A nerve block is sometimes used this means that your arm is numbed for the procedure. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

The physiotherapist will come and see you before the operation to teach you the exercises you need to do after the operation, to help you to recover. However if you are admitted as an emergency this might not always be possible.

The most important preparation is for you to understand what the operation involves and for you to feel comfortable with your decision. Remember that staff are here to answer any questions you may have.

Day of operationShow [+]Hide [-]

You will not be able to eat or drink for a period of time before your operation. The nursing staff will advise you on admission when you should stop eating and drinking in preparation for your surgery. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once in the anaesthetic room you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic. If the anaesthetist has advised you that you are having a nerve block. This will be explained to you fully at the time.

After the operation - the first 48 hoursShow [+]Hide [-]

After a short stay in the theatre recovery area you will return to the ward. 

When you come back from the operation your wrist will usually be rested in a plaster splint/backslab to keep the wrist immobilised and it will require high elevation in a Bradford sling for a further 48 hours.

You may have a ‘drip’ in your arm, which ensures that you get plenty of fluids, as you are unable to take any by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

Once the swelling has subsided your wrist will be put into a short arm plaster cast. You will also have stitches in the wound and these are usually removed 10 – 14 days after the operation, usually at your first outpatient appointment.

Many patients worry about how painful wrist fixation will be and all staff understand this. It is usual to experience some discomfort  and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

What problems can occur?

 

No operation is without the risk of complications. Your surgeon and therapist will explain any particular risks/complications of you operation before surgery.

Swelling is common after surgery and might be treated by elevation.

 

Is the operation always successful?

 

The surgeon’s expectations of your operation will be discussed before surgery (usually when initially seen in outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your discharge

Your length of stay in hospital will vary depending on the swelling at the operation site and on your individual circumstances. Once you are moving around safely on your own, you will be discharged home as soon as suitable arrangements can be made.

 

Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding your discharge please discuss these with your named nurse.

 

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

 

If your named nurse feels you and your carer will require extra support she will discuss this with you and with your permission will arrange for you to talk with the hospital social worker and Occupational Therapist.

 

If you live in the Newcastle area you will be assessed by the Orthopaedic Discharge Team (ODT) who will assess your suitability for the scheme which provides a two week supported discharge with nurse, physiotherapy and Occupational Therapy involvement.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

 

The day of discharge

 

On the day of your discharge your named nurse will give you some things to take home, these will include:

 

  • A letter for your GP (in some instances this will be posted): this should be handed in to your GP by either a relative or friend on the next working day following your discharge.
  • Medication: Any medication you have bought into hospital will be returned to you. You will also be given a weeks supply of any new medications. The nurse will advise you on how and when to take these.
  • Outpatient Clinic Appointment: You will be given an appointment to be reviewed in clinic. If transport is required this can be arranged by contacting your GP providing a week's notice where possible. If for any reason you are unable to attend your appointment please contact the outpatient department to rearrange the appointment.
  • Care Plan: If you have a care package arranged you will receive a copy of the care plan from the Social Worker before your discharge home. This is for your own information.
  • Discharge Record: This provides details about your stay and is for your own information.
  • Plaster Instruction (if required): The nursing staff will provide you with instructions on how to care for your plaster once you are at home.
  • Mobility aids: It is important that you have your walking aids and any other equipment that you require.
  • Patient information: Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
  • Valuables: Please ensure you have all your valuables with you.

General advice after dischargeShow [+]Hide [-]

You should anticipate at least a 12 week period of convalescence at home before you are able to resume your normal activities.

  • Exercises: Your physiotherapist will explain the exercise you should do following your discharge and if appropriate the ward physiotherapist will arrange an outpatient physiotherapy appointment.
  • Work: How soon you are able to return to work will depend on the type of job you do. You should discuss this with your consultant when you see him in the out-patient department.
  • Wound care: Keep your wound and plaster dry. Your stitches or clips will be removed when you attend the Outpatient clinic. You should not bathe while you have a plaster in-situ, however you may shower if your plaster is covered with a waterproof bag.
  • Pain: Take your painkillers as prescribed. Do not take more than the stated dose.
  • Cars and driving: It is inadvisable to drive while wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. The consultant will advise when it is felt that driving will do you no harm.

Follow-up

You will be followed-up as an outpatient at regular intervals after your discharge from hospital. Please use this opportunity to ask questions and discuss any concerns you may have. You are also welcome to call the ward for advice, following your discharge from hospital.

Contact numbersShow [+]Hide [-]

Below are some links and contact numbers you may find useful once you have been discharged, please do not hesitate to contact any number for additional help or advice:

Outpatient clinics

Wards

Other contacts

Physiotherapists

  • Royal Victoria Infirmary: tel 0191 233 6161 - ask the switchboard operator to Bleep 1899 or DECT 29370.
  • Freeman Hospital: tel 0191 233 6161 - ask the switchboard to contact the Senior 1 physiotherapist orthopaedics.

Occupational Therapist 

  • Royal Victoria Infirmary: tel 0191 233 6161 - ask the switchboard operator for the Occupational Therapy Department and ask for the Orthopaedic Therapist.
  • Freeman Hospital: tel 0191 233 6161 - ask the switchboard operator for the Occupational Therapy Department and ask for the Orthopaedic Therapist.

Social Worker

Call the relevant hospital on 0191 233 6161, and ask to speak to the Social Worker.

Pharmacy Helpline  

  • RVI, tel: 0191 233 6161 - Monday to Friday 9.00 am - 5.00 pm.
  • Freeman Hospital, tel: 0191 223 1230 - Monday to Friday 9.00 am - 5.00 pm.

Health Information Service     

0800 66 55 44

Orthopaedic Discharge    

St Nicholas Hospital Team, Campus for Ageing and Vitality switchboard, tel: 0191 233 6161 and ask the operator to bleep 1514 or to connect you to extension 28855/28856

Loan equipment

  • Newcastle, tel: 0191 219 4662
  • North Tyneside, tel: 0191 200 6184
  • South Tyneside, tel: 0191 454 0927
  • Northumberland, tel: 01670 730595
  • Gateshead, tel: 0191 402 6433 (ask for home loans)
  • Durham, tel: 01388 812 812
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