Richard Haynes PTA/CPT - 9/7/2008

Question
facts:
1.52 yr old active adult
2.fell ice skating-broke wrist
3.immediate ice application, reduction at em
4.next day met with orth. surgeon
5.orth. surgeon said reduction was good, no need to re-cast
wait 6 weeks
6.week 5 went back to orth surgeon due to swelling
orth surgeon was not concerned-said come back next week
7.six days later swelling increased-called orth surgeon left message on answering machine  

8.answering service-did not return my call
9.went to orth surgeon for cast removal after 6 week wait period
10.after cast was removed by x-ray tech, hand swelled up to approx 3-4 times it's orginial size.
11. x-ray tech said i could lose hand and went to get surgeon immediately
12. orth surgeon said find a hand physical theraptist
13. i chose to remain on the site and go immediately to the hand therapist there-did 4 hr work on reducing swelling

my question:
couldn't this swelling issue been avoided week 5 when i went into see the surgeon?

shouldn't my call have been returned from the answering service?


Answer
Hi and thanks for the question.   I suspect with the details you gave us that the swelling could have been better managed. Its not unusual to see a hand or wrist swell for weeks after a fracture as for the most part the patient will have the in what is called a dependent position. In other words the arm is left hanging down unless it kept constantly in a sling. Even if placed in  a sling during the day that will only reduce the swelling hopefully to manageable levels.

Maybe with a further explanation by the surgeon when he was seeing you for follow-up as far as what to expect along with care etc... some of the swelling MAY have been curtailed back at week five.

As far as leaving messages with the answering service and not getting a call back, I would like to think all calls are returned and that there is really no excuses. Possibly another MD covering decided not to call or even worse didn't get the message?

Hopefully things will now improve and you will get the full use of the wrist again after your therapy follow-ups.

Richard Haynes
Punta Gorda, Fla.
www.totaljointfitness.com