Joe A Shaw PA-C - 3/6/2008

Question
A couple of years ago I fell and had a very bad Colles fracture.  The ER doc put the bones back in place and put me in a large splint and told me I had to have surgery.  The surgeon put on a K-wire and plate.  He removed the k-wire in the same surgery.  He sent me home without a cast or splint and strict instructions to use the hand.  The next day I tried to use it, and experienced severe pain.  He wouldn't let me come in despite many calls.  Two weeks later he chastised me for not using it,  I told him the bone was still moving and I couldn't use the hand.  He put it in a short cast, but it still kept moving. I think he should have put it in a cast after surgery and it should have been a big cast that kept the arm from moving. He is a board certified surgeon and is saying he followed standard procedure and that the residual problems are from the fact I didn't use it.  Am I wrong? Thank you very much.

Answer
Pat,
By it being an ORIF open reduction internal fixation procedure, that tells me it was a pretty severe break..because a lot of Collies' can be set manually (externally). You do want to keep your FINGERS active within reason...but not your wrist. You use the word "hand"..so I don't know. When you fixate with plates, screws etc..that is like a cast...it is keeping the bones together actually better than a cast would do, in this situation. I don't know about you saying the bone was moving? that doesn't sound good. Sometimes they will add a short arm cast to stabilize the whole area..if he feels the plate etc..needs help. Sometimes it is hard too tell right then during surgery..and on follow-up, and X-rays the decision will be made. I know you have been through a lot. I will provide a detailed link on ORIF and Collies' fxs

http://www.wheelessonline.com/ortho/orif_of_distal_radius_fractures