A Broken Wrist: Can We Rebuild It?

January 9th 2014 will be ever cemented in my mind... I wish I could post an exact time to it, I can't, though based on my phones call log, the time frame is between 5:30 and 5:50am... it's when I crashed on my mountain bike. It's not the act of crashing though, it's the act of that crash reaching it’s crescendo that really counts, as points on the body make contact with the ground and your life is never the same.

Now... my world did not end, I did get on to my feet. I summoned help via the wonderful mobile phone technology that has defined the early 21st centuary and met emergency responders as I was attempting to walk out with my bike. I was battered, I was bruised and my left wrist was broken (technically it's described as: impacted intra-articular fracture of left distal radius with ulnar styloid fracture).

Note: The picture above is by my son Luka, he is 6 and I think he captured it all quite well.

Assessed, made comfortable and in an ambulance I was whisked to hospital. There it was treated, via a Biers Block procedure, everything was manipulated into place and secured in plaster (a lot of plaster!). Check-ups kept me updated and I was hopeful of a quick return to normality (i.e. back on the bike), however that was not meant to be. Somewhere, sometime, the bones in my arm moved within the cast and when it came off I was left with a wrist that was only doing about 20% of what it used to do.... oh shit-cakes!

There was good... I could do my chosen work option, I could drive, I could do a number of the things we need to do as modern first-world citizens making our way through life, at work and at home... what I could not do though was open jars/bottles, lift boxes, assemble things, dig in my garden, basically anything that required the ability to turn my wrist, or strength... as time went by and I did a program of rehabilitation, I regained 35% use and strength and I could return to riding my bike. The reality though is it was not enough, so I pushed for a solution when I was assessed by the doctor. The upshot is I was approved for a surgical solution.

My surgeon is a highly animated Londoner by birth, New Zealander by choice and source of much amusement for me, though I’ll be honest and say there’s a good deal of dread and discomfort in there as well, especially as he described how my injury could be best treated. Essentially the movement of the radius and ulna, as a result of the crash has caused my wrist to 'stop' rotation.

If you can image your hands our in front of you, palm down, then you rotate them so they are now palm up.. well my left wrist only went 35% of the way toward being palm up (and curiously also only had ~35% of the original strength), to remove the stop, the first option is to lengthen the radius. If that failed, then the ulna would need to be shortened, but essentially it’s one step at a time.

To break it down to it’s most basic, my arm would be opened up, the radius cut and lengthened, with a shim of bone placed in it. Finally a plate would be attached to keep it in place permanently. I’m not entirely sure how you pictured that in your head… in mine it involves sawing the radius bone through, pushing it apart and ‘glueing’ something to hold it apart and screwing in a strip of metal… after all, how hard could it be?

So before I tell you how hard it can be, I’ll return to my surgeon, Simon. As I was being prepped for surgery Simon informed me of the variety of options he had from reviewing my x-rays and scans. He then proceeded to explain that bone was like a Crunchie Bar, chocolate on and the outside, honeycomb in the centre and depending on what he discovered during the operation would help make his choice. Not sure if you can picture it, but my last thoughts as the anaesthesia took hold of me was… well… Crunchie Bar… how hard can that be…

Seems a lot harder than I thought, the bone was not sawn in half, but rather a segment removed and opened up to be filled with a piece of my hip (both chocolate and honeycomb), that was enough  to change the length and angle so that my wrist ‘rolled open’. Insert and screw on a plate. Happy surgeon.

Post-operation, well I’m a few days from the cast coming off yet, by the wrist does fell a lot more free than I thought it would… as for the bone graft site, that’s been a bit more problematic. I’ve developed some inflammation in the wound site which has slowed me down. It’s certainly given me a different perspective on hip issues and why hip breaks and replacement operations are a big deal for the elderly. The amount of pain and trouble has surprised me.

So what’s next?

Return to the surgeon for removal of that cast, which will be replaced by a splint and instructions of what exercises I can start on to free up movement in my wrist. A rehabilitation program will begin in 4-6 weeks and I can ride again in 8, but I had to promise no racing through the summer season…. stay tuned.

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