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Swollen wrist and limited movement after ORIF

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Hello everyone!

Let me first summarise my case:

*Accident which resulted in a fracture in my ulna.
*2 weeks in a cast to try natural healing.
*After 2 weeks the bone wasn't healing well and thus the doctor opted for an operation. A plate with 6 screws was placed.
*The put a long cast (from fingers to bicep) on for 2 weeks.
*The cast was removed last week (6 days ago). They did not take any new xrays. They recommended practicing and told me not to put any weight on the arm for the next 5 weeks.

The day when they removed the cast I really took it easy and did little but watch some TV and tried to give the arm as much rest as possible. The next morning I noticed my wrist was swollen. Not incredibly big, but definitely swollen. I started practicing a little bit over the next few days. Especially the movement in my elbow was returning quickly (I was unable to stretch after the 4 weeks in a 90 degree cast).
Now 6 days later my wrist is still swollen. There is little to no in/decrease since when it began. This swelling makes it very hard to move my fingers (e.g. make a fist). I was able to do this initially when the cast came off. Also the movement in my wrist ranges from palm down to thumbs up. Going beyond thumbs up (so palm up) is not possible. It might be a few millimeters better than when the cast came off, but it's hard to judge for me, despite practicing.

I have called the hospital and they don't have a doctor available, but they will call me back to make an appointment, somewhere in the next few days.

My questions:
*Is the swelling normal/harmful?
*Is it normal to have such limited range with my wrist?
*Is 5 weeks of practicing without any load normal?

The hospital has been very reluctant to give out information. So I'm forced to use google to find information, but the information I find seems to be very case specific. Or very negative with all sorts of horror stories Wink.

Any information is greatly appreciated. Thank you for reading!
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First Helper User Profile Gaelic

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replied January 16th, 2012
Especially eHealthy

The swelling in the wrist is not uncommon after coming out of a cast. Have you kept it elevated above your heart level? Anytime you are not using your upper extremity very much, it will have a tendency to swell. The venous blood and edema is moved back into the body by the action of the muscles and gravity. So, if you are not moving your fingers and wrist a lot, the edema will just sit around.

You should apply some light compression, with a ace wrap from the base of the fingers to the armpit. You should elevate the hand above your head, yes, above your head. Also the more your can move the fingers the better.

As to the decreased motion, that is quite common also after being immobilized for a while. But, with an isolated midshaft ulna fracture, your motion should come back fairly quickly.

You do not state how the ulna fracture occurred, or where it is located along the ulna. If it was a direct blow (called a nightstick fracture), then the joints at the wrist (DRUJ - distal radioulnar joint) and the elbow (radioulnar joint) are usually not affected.

However, if you sustained the fracture by a fall onto an outstretched hand, then it is possible to injure the joints. Sometimes injuries to the joints are overlooked during the initial evaluation, because the joint has reduced itself. There is an injury called a Monteggia fracture, where the radial head dislocates at the elbow when the ulna breaks. But, it is also possible to injury the DRUJ at the wrist, with an ulna fracture. The DRUJ is where the forearm rotates, with the radius rotation around the ulnar head.

If you are not getting your full pronosupination (putting the palm up and down) back, you need to have the DRUJ examined. Also, sometimes, when the ulna is fractured, scar tissue will form between the radius and ulna, in the interosseous membrane. This can reduce forearm rotation. On rare cases, bone will actually form in the interosseous membrane, connecting the two bone together, reducing motion. This is called a synostosis.

It usually takes about 6 weeks for an ulna fracture to heal. So, they were being a little conservative in not putting weight on the forearm for 5 weeks, but, you have to remember the plate is just an internal splint. It is possible to pull the screws out with a violent twist of the forearm (such as catching yourself in a fall). So, active range of motion of the forearm (doing the motion yourself, your own muscles) is okay, but you should not be doing hand stands or pushing/pulling with the hand, till the bone is united.

But, while you are waiting to see a surgeon, you do need to get the swelling down and get your finger motion back. While in the cast, you should have been working on the fingers, but if not, now is the time to get on that. Moving the fingers will help with the swelling in the wrist, a lot. using something like TheraPutty is great, as it allows you to get your fingertips all the way down into the palm. Squeezing a ball is basically an isometric exercise, because the fingers do not move very much. And what you want is full finger motion.

Work on getting the palm up and down. This will take some effort and time. But, again, if the motion is just not coming, you will need to have the DRUJ examined and the forearm x-rayed to make sure the plate in in proper place and there is no synostosis.

Good luck. Get the swelling down and your finger motion going.
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replied January 16th, 2012
Gaelic, thank you for your great reply!

I will immediately start working on the fingers and put an ace wrap around it!

It is indeed a nightstick fracture. A direct impact on my ulna, which caused the fracture. While I was at the hospital, I have taken a picture of the plate from the computer screen: naplate.jpg
This was immediately after the operation. I hope this will be useful.

When the accident occurred they have taken two x rays of the elbow and they said it was fine.

I am working on my fingers as I type, thanks again!
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replied January 16th, 2012
Especially eHealthy

The reduction and plating of the ulna looks fine.

From only one view, it is not possible to tell if there is anything going on in the DRUJ. But, again, if the pronosupination gets better, it is probably okay. If you do not regain the motion of forearm rotation, do have someone take a look at the distal radioulnar joint.

Work on those fingers, as their motion is very important.

Good luck.
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