Editor - Colin Blythe.We often imagine a broken bone as an injury that only occurs after a relatively severe accident so it can be surprising to discover that some bones can be fractured very easily.
This is certainly the case with the wrist; many broken wrists are sustained from simply tripping over and putting your hands out to protect yourself. There are some small bones within the wrist and it’s not difficult to break them, causing pain and swelling.
In the past you may have seen individuals with big, heavy casts on their arms deliberately designed to prevent the bones from moving but is that how broken wrists are treated? Here’s a closer look at how broken wrists are treated now, and how this differs from a few decades ago.
Historical Treatment
Once more was understood about the physiology of broken bones, it became very clear to doctors that keeping everything still while healing took place was a real priority. This has been known for a couple of centuries but historically doctors lacked the technology to be able to achieve this.
In the 18th and 19th centuries, amputations for broken bones were commonplace because the bone couldn’t easily be set and the limb would become weak and useless, or worse, infected. This was particularly the case with joints such as the wrist where amputation was relatively simple and the bones involved were small and easily fractured.
By the 1950s, knowledge and treatments were evolving fast and two doctors were at the forefront of pioneering changes. Dr Robert Danis and Dr Maurice Müller were at the forefront of the new treatments which sought to improve on some of the barbaric methods which were still being used for broken limbs.
It would be fair to say that these two medical practitioners were the inspiration for modern methods of nailing and plating, and were responsible for starting the shift towards more modern treatments.
However, back in the 1950s and for many of the following decades, huge emphasis was placed upon not moving the broken joint. This often meant a heavy cast was required and the joint was kept completely still.
This had the desired effect on the broken wrist, but recovery was often more complex and could take some time. This wasn’t entirely due to the bone, but rather the soft tissue which had been left completely immobile. Some individuals never fully recovered their full strength in the affected arm, due to the loss of tone in the soft tissue, rather than the fracture itself.
Some broken wrists needed to be pinned together, or held with plates and screws. Historically, stainless steel was used for any inserts but by the mid-1960s, titanium was starting to be more widely used. This is lighter than steel but also very strong, providing the best of both worlds.
At this time, plates and screws were often removed after the bone had healed. This is because they could be large and bulky and their design carried the risk of necrosis of the surrounding bone area.
Current-Day Treatment
In many ways, the modern treatments for broken wrists is similar to 50 years ago. The principle of trying to immobilise the broken bone remains just as important, and in some cases surgery may still be required to pin the fracture together.
However, one of the key differences is the understanding that while the bone must remain stable in order to knit effectively, the surrounding soft tissue must also be considered. The wearing of heavy casts which completely immobilise the whole arms for long periods is now considered to be counterproductive.
Instead, although casts are still used on the wrist, they have been designed to be far lighter than before. This reduces the weight and pressure on surrounding tissues and makes it easier to move the rest of the arm around. Fingers can be moved, albeit in a reduced capacity to prevent the soft tissue complications that can be caused by total immobility for a prolonged period.
The 1950s were a decade that was extremely important for the development of surgical pins, plates and other fixations. Setting the foundations upon which future developments could be built, progress was just starting to be made to identify lighter, more permanent implants.
Fast-forward to the modern day and many pins and plates are now left in-situ. Deliberately designed to be capable of remaining in the body forever, these fixings are light, durable and strong with the ability to fuse well with the surrounding bone.
Steady Progress
Modern treatments for broken wrists is based upon historic knowledge and unlike in other areas, sweeping changes haven’t particularly been made. Instead, surgeons have refined materials and techniques to improve upon what was used in the past. This together with an improved understanding of soft tissue damage means the outcome is far better compared to five decades ago.