Orthopaedic Surgery - Wrist Open reduction and Internal Fixation (ORIF) - Volar approach

Procedure

The wrist is an important joint. When it has broken, it is important to try and put the bones back into as close to a normal position as possible.

Your surgeons therefore feel an operation may be necessary. The surgeon can only operate if the swelling is not too great.  Keeping the arm up (elevated) will help not only reduce this swelling but also lessen the pain.

Your surgeon will visit you before the operation. If you have any questions, now might be a good time to ask them. Your anaesthetist will talk to you about the type of anaesthetic. This may be a general (when you are asleep) or regional (when only an area of the body is numbed, and you remain awake).

When you are in theatre, a tight inflatable band may be placed across your upper arm (a tourniquet). This is to limit the amount of bleeding.

Your skin will be cleaned with antiseptic solution and covered with clean towels (drapes). The surgeon may then ask for X-rays to be taken of the broken wrist and will attempt to 'move' (manipulate) the bones into the original position. Regular X-rays will be taken to see how the bones look.

The surgeon will make a cut (an incision) on the inside of your wrist (just before the palm). The blood vessels and tendons will be noted and moved to one side. The surgeon will again move bones to a better position and place a plate. The plate will be held in position with screws. The skin is then closed with stitches (sutures) which may be under the skin (dissolvable) or above (the skin). In this case the stitches will need to be removed in 10 to 14 days. Even after this, the wrist may be placed in a plaster cast for extra support.

Afterwards, your arm will feel sore. This is normal. It is extremely important that you keep your arm up (elevated for the next week at least). This will help bring the swelling down. You should also try and move your fingers – this stops them becoming too stiff. The cast can be removed after 3 to 6 weeks.

Please be aware that a surgeon other than the consultant, but with adequate training or supervision may perform the operation.

Alternative procedure

The fracture may be left in its current position in a plaster. If it is not in a good solid position, it may not heal as well. This will make it more likely to cause, arthritis, pain and disability.

You may of course seek a second opinion.

There may be other forms of fixation, such as wiring or external fixators. These may not be appropriate for your case. You should discuss these with your consultant.

Risks

As with all procedures this carries some risks and complications.

Common (1-5%)

Pain

Your wrist will be sore after the operation. Keeping the arm up (elevated) most of the time will help reduce the pain and swelling. We will also give you pain killers. If you need more, however, please ask a member of staff.

Rare (<1%)

Infection

Unfortunately, even though the surgeon inserts the plate in theatre where everything is sterile and your skin is cleaned, there is still a small percent of patients who develop an infection. Most infections will present as redness, swelling or even a discharge of fluid or pus. A course of antibiotic may be needed. If the infection is severe, a further operation including removal of plate may be necessary.

Neurovascular damage

There are numerous blood vessels and nerves that run through and around the wrist. This means that they may be damaged by the plate as it is put in. This might lead to numbness or weakness of muscles. This may be temporary or in very rare cases, permanent.

Compartment syndrome

This is a build-up pressure within the forearm and can cause pain, nerve damage, blood vessel damage and muscle damage. If this occurs, an emergency operation will have to be performed.

Slipped position

Despite manipulation, plating and cast application, the fracture may very rarely still slip. A further operation may be necessary.

Removal of plate

This is not usually necessary unless there is infection or severe restriction in movement or pain.

Arthritis

Any stiffness at the wrist or elbow may occur despite adequate reduction. Arthritis may be more common if the fracture involves the joint.

CRP syndrome

This is pain, swelling or stiffness around the fracture site and may occur even months after the original injury.