Joe A Shaw PA-C - 1/25/2008

Question
My husband was in a car wreck on 12/15.A sixteen year old boy crossed the center line and hit hhim head on. His wrist was fractured by the air bag. He was put in a short arm cast for four weeks.The bone was actually chipped. There has been no bone growth and the pain is almost constant. An MRI was preformed and it was found that he has torn cartliage around the fracture.He also has tendonitis caused from having his arm casted. Yesterday he was given a cortosone(sp?) shot for pain.  The doctor is sending him to three weeks of therapy and he is in a wrist brace now. What is the likely hood that he will not need surgery to remove the damaged cartliage? Also is this something that would be considered a life long injury or will it eventually be healed and normal again? He is a correctional officer and has not been able to return to work since the accident.I also cant understand why the chip from the bone is being left in his wrist,cant that be causing some of the pain? The doctor says that it isnt hurting anything and will be left in.Does that sound right to you? I feel like I would like a second opinion but hubby thinks I am being paranoid!

Answer
Leah,
I think everything is going about as well as expected. It has only been about 6 wks since accident. A "chip fracture" means that a little piece was broken off...so sometimes there's no bone growth that is visible on xrays anyway, b/c the chip is so small. There is a possibility he has a TFCC tear (a cartilage complex within the wrist) that could have been torn, if this is the case, he will need or should have this repaired by surgery(same day surgery-scoped, usually not a big deal)
You definitely would not operate to remove a chip at this point if ever..Only perhaps if it was within the actual joint surfaces would this be indicated, and the ortho was certain it was causing problems. I see xrays every wk where people have chips in ankles,hands, wrists etc...sometimes they can't remember what happen..sometimes they say, yeah that was from an old highschool football injury etc..
If he is not a whole lot better in 3 mos, then seek a 2nd ortho opinion. TFCC's and wrist injuries/fractures can give people pain their whole life and he possibly may have arthritis in that specific area down the road. But I would think he should be able to get back to 100% even if he needs his TFCC repaired. I would think he could go back to work soon but with restrictions? unless his employer doesn't allow that.
Good luck
J.Shaw PA-C