Malunited colles fracture
Q: I met with an accident last year and my right wrist got fractured. Immediately I went to a nearby hospital and got a plaster of paris bandage which was removed after 3 weeks, after which it was found that there was a prominent bend and I could not move my hand in the supine position. The doctor advised me physiotherapy (a few exercises and wax therapy) which I took for more than 3 months. But no improvement was found and was not able to use my hand normally. We then consulted ortho specialists and it was diagnosed as malunited Colles fracture and had to undergo surgery (corrective osteotomy) to correct the anterior displacement of the distal radius. My concern is that even after 10 months of undergoing surgery, I still have pain in my wrist and hand whenever I do some work like washing clothes or cooking. Are there any chances of improvement and will I ever get back my normal movements. Will there be problems like arthritis in future because the bones around my wrist are weak now? Please advise me.
A:The cause of your pain may be Carpal tunnel syndrome. It is common after a colles fracture. in this syndrome, there is a compression of the median nerve due to an alteration in the anatomy. This can be corrected by a surgical release of the carpal tunnel. The best way to diagnose it, besides examination, is to do a NCV (nerve conduction velocity) test of the median nerve. The other possibility is sympathetic dystrophy. This is due to alteration in the autonomic innervation of the limb, leading to significant pain, swelling and decreased range of motion. The other possibility is a non union of the osteotomy. That means that the osteotomy done for correction of malunion has not united and that can give rise to significant pain. As far as the range of motion is concerned, you should not expect increase in the range of motion, one year after the intervention. That is the maximum you could get, depending on the type of fracture, malunion and recorrection.