Surgery is not always for everyone. We look at each patient’s individual circumstances to determine the best path forward. Recently an elderly patient with a distal radius wrist fracture walked into our evening injury clinic. Though still active and independent her heart and lungs were not healthy enough to tolerate anesthesia. We discussed a manipulation and resetting of her fracture in the clinic in our X-ray suite. This is not for the faint of heart, but our patient was brave and agreed to proceed.
With local anesthetic administered into the fracture site (commonly called a hematoma block), we were able to obtain some analgesia. Taking advantage of an IV pole and some weights (sand bags hanging as seen in first picture above) we suspended her arm using the chinese finger traps (see second picture above). With our friend gravity, we were able to get her compressed fracture out to length. Finally using 3 points of pressure along the length of the forearm (as shown in first picture), the plaster was molded to help maintain the appropriate alignment of the fracture.
In the end, our patient was happy to avoid the risks of anesthesia, and grateful that we were able to take care of her in the clinic that night! When I was a resident at Johns Hopkins Hospital, doing these reductions and manipulations were a nightly affair. These reductions are rewarding and fulfilling since you are able to not only diagnose the problem, but also provide the definitive treatment in the same encounter. As a practicing surgeon now, most of these are managed acutely in the emergency room.