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Musculoskeletal Services

Fractured Wrist Manipulation Under Anaesthetic

IntroductionShow [+]Hide [-]

This information has been designed to give you and your family a basic understanding of what manipulation 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. Most wrist fractures are easily treated with the application of a plaster cast. However, in some cases manipulation is required to ensure the fracture is in the correct position for healing. Your consultant will discuss with you the most appropriate form of treatment 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-operative 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 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 and follow upShow [+]Hide [-]

The first 48 hours

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 cast to keep the wrist immobilised and it will require elevation in a Bradford sling to help reduce the swelling.

Many patients worry about how painful wrist manipulation 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.

Getting up and about

You will be allowed up 4 – 6 hours after your operation with your arm elevated in a Bradford sling. Your physiotherapist will teach you appropriate exercises. It is important to exercise the shoulder, finger and elbow joints to prevent joint stiffness and muscle wastage.

What problems can occur?

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

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 then you will be assessed by the Orthopaedic Discharge Team who will assess your suitability for the service, 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 brought into hospital will be returned to you. You will also be given a 7-day 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 will be arranged by the ward clerk when making the appointment. 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 The nursing staff will provide you with instructions on how to care for your plaster once you are at home.
  • 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 discharge

  • Exercises Your physiotherapist will explain the exercises you should do following your discharge.
  • 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. He will advise when he feels driving will cause you no harm.
  • 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 surgeon when you see him in the Outpatient Department.
  • Pain Take your painkillers as prescribed. Do not take more than the stated dose. Contact your doctor if you have any pain or swelling in your calf or if you have any chest pain. Ache in the wrist on heavy activity and in cold conditions is normal after a wrist fracture for 18 – 24 months.

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.

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