Distal radius & ulna styloid fracture

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The full diagnosis said: Distal radius & ulna styloid fracture, mild shortening of distal radius with a degree of dorsal comminution.

First of all I must say how grateful I am for Jeanettes postings, they have given me great info & encouragment. I have read all I can find as I am so disappointed in my progress to date.

My injury happened on 6 Jan'15, 2 days after getting my puppy, whilst playing in the garden with her, I tripped & fell heavily landing with my full weight directly on my left wrist which bent up towards the inside of my arm at a very strange angle. I just had to lay there for a while wondering how to get up agin - the pain was excrutiating.

I thought it was a bad sprain so used frozen peas as it was swelling, then ice water before a makeshift sling. Online advice said wait 24 hrs b4 seeing doctor to allow for swelling - so i did. 

When I saw a doctor he said almost certainly broken & gave me a note for xray at hospital. Xray dept closed at 4pm so went next day where breaks confirmed & reduction plus back slab given which despite gas is horrible painful experience then back to xray.

Consultant said he was fairly happy with reduction altho radius was still a bit twisted & to wait a week to see if had stabilized otherwise surgery which I said I didn't want if can be avoided.

One week later xray confirmed was stable & doctor says surgery not necessary so cast applied (below elbow to wrist).

The following week, another xray & doctor says healing progressing & gap is closing. Come back in 4 weeks which will actually be 5 wks as hosp want to wait for results of Dexa scan. Consequently, will have been in cast for 7 wks by then.

So today I have been in cast for 5 wks & I am still in much pain. I wriggle fingers & clench as far as I can but they are still very swollen. I cannot dress myself, wash properly, butter bread, or anything much at all, even opening a letter is tricky. I can hold light objects in my fingers but a cup of tea would be too much.

What really worries me tho is that I have little rotary movement - cannot see my palm or back of hand.

Is this all normal & to be expected or am I just being impatient?

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16 Replies

  • Posted

    Dear Mari-Elaina

    What you describe is almost exactly what it's been like for me, except that I had an operation. As long as my arm was in a cast I couldn't do any of the things you mention, or only if I used the other arm. The pain went up and down, but remained intense for a good six weeks and I kept taking painkillers throughout (in fact I only stopped them 2 weeks after the cast was removed).

    Once the cast was removed, all of the nerve pain went away, but there was still quite a lot of pain, mostly soft tissue, and on some days it was quite intense. But it progressively reduced and I gradually began to get some flexibility. It took a few weeks after the cast was removed for the swelling to go down.

    It's now 4 and a half weeks since my cast was removed and I'm slowly gaining more movement but I expect it will be a couple more months before I have something like the movement I had previously, maybe longer to get full movement back. I'm still very careful lifting things, but I see improvement every day, and it gets very "achy" at different times. 

    My physiotherapist told me that I should have started therapy while my arm was in the cast. There may be different views on that, but I know it's essential that you exercise your fingers as much as possible to prevent other side effects and the get the blood flowing to your fingers - this in turn will help reduce swelling. 

    It might be hard to believe but you've got past the worst and once the cast has gone, you'll start to see some real improvement. I had the same concern as you, wondering if my experience was normal, but although we're told that each experience is different, yours sounds pretty normal to me. It takes time, but you'll get there. Good luck!

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    • Posted

      Thanks so much for replying & telling of your experience, it gives me much needed reasurance.

      To be honest, there have been improvements but they seem relatively small after 5 wks in cast although I've rarely needed pain relief this week preferring to know when it hurts. I do take 500mg paracetamol if it gets too bad tho but no codeine now.

      I do keep fingers wriggling & clenching but straightening them is painful & the cast is limiting. Swelling seems stuck but at least they don't look like pork sausages anymore, middle, ring & little finger are the stiffest (ulna side).

      It will be another 17 days b4 I see the consultant again & hopefully have the cast removed. Physio is going to be a long hard process but I feel better prepared for that now.

      I am so longing to play with my pup, get dressed, eat a sandwich made by me, wash properly, do my hair & a myriad of other things. Driving & gear changing is going to be some time in the future. Small steps & a lot of patience needed!

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  • Posted

    I had a terrIble, splIntered compound SmIth's fracture of the radIus (hand bent forward), followed by surgery, tendon repaIr, and metal plates, and the ulnar styloId was removed. After 2 months In a cast and than another couple In PT, I stIll had a purple hand wth severe edema, serIous paIn, and very lIttle ROM. I'm and artist, need my hand back, and almost drove my doctor nuts untIl he fInally agreed to go over the post surgery xrays wIth me. He explaIned that the planes along whIch the bones can slIde were all In place, and that there was no reason I shouldn't regaIn full ROM.

    He recommended aggressIve physIcal therapy, (whIch I dId NOT get due to possIble CRPS; very bad). He also saId I needed to work on the scars to get rid  of bad adhesIons, and prescrIbed an edema glove, whIch I wore faIthfully for months.

    It's been almost 9 months of GENTLE PT, OT and adhesIon care. I have about 75% full ROM, so I'm very happy and shooting for 100%.

    FIrm but gentle Is the rule; 3 out of 10 on the paIn scale when workIng on hand.

    Long, 1-3 mInute stretches, my PT tells me. And 30+ mInutes In the splInt.

    I now use a dynamIc splInt, whIch we call "the cranker", to Improve flexIon and extensIon.

    You may have to work long and hard to regaIn rotatIon, and It's faIrly paInfull, especIally to see the back of your hand. It was recommended to me that I take 1000mg vIt C, vIt D3, calcIum, and EspecIally organIc *vIt K2*, and I do so relIgIously. Your tIme table sounds sImIlar to mIne, and I'm pretty happy to be healIng so well, thanks to my wonderful, arrogant hand surgeon.

    Best of healing to you!

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    • Posted

      Hats off to you Mary to have such guts and determination. I've been sorry for myself for for the past 3 months but I can't imagine how difficult it must have been for you. One thing I've learnt from this experience has been to better understand just how tough a broken bone can be, and my PT (kinésithérapeute in French) tells me that the wrist is one of the most difficult bones or set of bones to heal.

      I saw my dermatologist 2 days ago (on a separate matter) and he recommended Bepanthen scar treatment - only works for external scarring of course, but I'm going to try it. Just wish I'd contacted him when the injury occurred. I had more advice from him about all aspects of the injury than I had from any of the surgeons.

      I'm paying out of my own pocket for PT, which might be more feasible here in France where medical costs are tightly controlled. I see the PT 3 times a week and he pushes the PT as hard as I can stand and more, I would say a 4+ when we started, depending on what I reported on my pain over previous days. The day after PT I'm always sore and I've had doubts about his approach as it contradicts just about everything I've read. But in 4 weeks of PT I've made huge gains in flexibility (after a very rough time after the op and in the cast) so I'm thinking it's worth it. Interestingly, in addition to the regular exercises, he gets me to hand write all the time (starting with great big letters). It's all about increasing blood flow to the fingers and reducing inflammation.

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    • Posted

      Pain or no pain with PT: the opinions vary.

      As long as it's working, it should be OK.

      i had to switch to the gentler route because i seemed to be getting CRPS, and the CRPS symptoms have abated.

      Hopefully you can do a lot of exercises at home, and save money on PT.

      i'm fortunate to have insurance, and count my blessings every day for that.

      (i think PT here is about $150 per visit).

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    • Posted

      Thank you, Mary, for sharing your experiences, as Cassp has said your ordeal has been one that shows pure grit & determination. After 9 months you've made tremendous progress & I feel sure you will gain full movement in time.

      i'm still in cast so am somewhat limited but fingers are moving much more freely altho flat down is not possible yet. Swelling has reduced too & I'm able to see front of hand sideways but back of hand is not visible yet.

      I don't understand why rotation is so slow to improve as cast is from below elbow to knuckles so rotation is not at wrist but at elbow, I suppose it must be tendons.  

      I can now hold say a small tin of soup (400gms) but need to work on grip.

      I'm regularly taking 2 x 600mg of calcium + vit D3 daily & will look into K2.

      Small steps & a big lesson in patience & vulnerability.

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    • Posted

      Thanks so much; truthfully, my story is more one of necessity than courage.

      What i've learned from all this is that we all go through it, sooner or later.

      (Old age ain't for wimps)

      i have a lot more sympathy for anyone with physical ailments than i used to.

      Small steps, and

      Hope you heal quickly, M

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    • Posted

      Hi Mari-Elaina, I think you're being a bit hard on yourself. Just having a cast seriously impedes your flexibility. You're doing much more than I was when I was in a cast and mine was also from elbow to knuckles. Even now I'm very careful with what I lift. But it's good to be warned - when it comes out of the cast your wrist will probably start hurting all over again. It's a wonderful relief but expect pain, for me it shot right back up but not as bad as immediate post-op. If you have PT consider taking a painkiller before you go, at least for the first few times. (I'm glad I was warned to do that, but I don't need to anymore).
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    • Posted

      You're so right. I'm 63 and never really thought about getting older until this experience. So now I need to take myself in hand and do some preventative work, fitness and balance and a bone density check. I agree, I feel much more sympathy for others with injuries - I've never properly understood the effect of pain until now. And I think it's very important that the people around you understand what's going on. 

      BTW, Mary are you in Australia, US or Canada? I was thinking about what you said about the cost of PT. Here in France I'm paying 35 euros a session, which is very reasonable (over a short-ish period, that is).

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    • Posted

      Hi Cassp, Thanks for the encouragement & also the warning about PT. 

      I'm approaching 65 next month & I know healing is a longer process when you're older.

      I go for a Dexa scan in a few days & will see consultant on 4 March, that will make it 7 1/2 wks in the cast, when hopefully it will be removed & PT will be starting. 

      I've always been pretty active but as you get older you start to notice things take more effort which I get impatient about but this episode has forced me to acknowledge my vulnerabilities.

      This website has given me more help, advice & understanding than any other thing I've read or doctor spoken to. I am so grateful to everyone that has taken the time to share their experiences.

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    • Posted

      i'm in the US. i don't know what they'd charge for self-pay, but i do think they get anywhere from $100 to $175 for 45 minutes or an hour, here, from the insurance. Then again, the insurance company usually gets a discount, so i'm not really sure...... but it's expensive.

      A regular short appointment with an Nurse Practitioner is around $100 and ujp, so there you go.

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    • Posted

      Hi Mary, I'm in France (I'm Australian) and my American friends tell me that medical costs here are much lower than in the US. I'm paying 35 euros for each PT visit, which is why I can manage it. I have international health insurance for the time I'm here but it's very expensive so I took a punt and only got covered for the main things (such as my operation and 2 days in hospital), not things like PT (which are extras). Even so, the cost of the treatment is much lower than the insurance would have been. I was actually in Spain when I had my stitches removed by a nurse (in an American clinic) - 18 euros, and she was good. Australia is closer in cost to France but here I was admitted to hospital very quickly and operated on the next day, don't think it would have gone as smoothly in Australia. (Of course there are downsides as there are in every system).

      I can see all this as interesting now that the worst is over.

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    • Posted

      Hi Mari, hoping it all goes well for you in 2 days time.Like you, I assumed it would take me as an older person a lot longer to recover, but I'm revising my thinking. 5 weeks out of the cast and I can do a huge number of things - I see improvements every week. Of course, it's stiff, especially in the mornings and there's a way to go to get full strength and flexibility, but I now feel very optimistic about the long term prognosis. Just be prepared for some pain and serious stiffness over the first 2-3 weeks and recognise that you still won't be able to do much at all - you will probably feel very protective of that poor little arm. Find a good PT as quickly as possible, use ice (and heat) and exercise. 
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  • Posted

    It's now 8 weeks on since I broke my ulna & radius. Cast removed a few days ago, still very swollen & bruised, fingers like pork sausages & stiff. It's pretty useless really & skin all flaky so smothered in moisturiser BUT the good news is that bones have healed & wrist brace is huge help as it's still so fragile & tender.

    The doctor told me to wear brace during the day but take it off in the evening when watching tv & do exercises. These were to raise hand from wrist & then to lower it, each way as far as possible, also to rotate hand from wrist.

    I find these exercises hurt immensely but not at the wrist - the pain is on back of hand up to a place 3/4 along the outside of my arm, it feels like nerves jangling & goes on for about 1/2 hour, pain killers (codeine) are making no difference to intensity.

    Since cast removal I am able to see back & palm of my hand if I rotate gently. With thumb to finger exercises I can touch 1st, 2nd & just about 3rd (ring) finger but not the little one.

    My personal belief is that as swelling diminishes movement will improve, back of hand to knuckles is quite swollen & feels warm & seems to be where pain stems from wheras wrist is just stiff. A bag of frozen peas certainly gives me some relief from the throbbing.

    Does any of this sound like anyone elses experience? 

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    • Posted

      Hi Mari Elaina, what you describe is very similar to my experience when I came out of the cast 6 and a half weeks ago, and already I can't believe how different I feel now from back then. I was also surprised by the intensity of the pain but it started to diminish quite quickly - it didn't go completely but did go much faster than after I first broke it. The pain will diminish as the swelling goes down and the best way to achieve that is to move it as much as possible. If you can possibly see a physical therapist, do. I credit mine with having a great deal to do with my increased flexibility and reduced stiffness and pain, he has pushed me far more than I would have done alone. I found ice essential and also heat. Love the shower and washing my hair.  

      Finally here's an analgesic cream that my dermatologist told me about. It's made by Merck and it's called Baume Saint-Bernard, adult analgesic cream. It gives brilliant relief from pain and stiffness. You can only use it for a week or so at any one time but when you apply it, it works for quite a long time (for me, more than 24 hours as I don't have much pain now). Wish I'd known about it 3 months ago.

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    • Posted

      Thaks for the info, Cassp.

      It seems the cream you recommended is only available from pharmacy in France (I'm in UK). I've ordered it as anything that helps will be very welcome.

      I will be seeing a PT but am waiting for appointment to come thru.

      It's not so much the stiff wrist that is troubling me but back of hand &  base of thumb up to elbow - this all seems like nerve damage to me & if aggravated makes me feel quite sick to the stomach. The area apart from being swollen is red & warm to the touch, the skin is sensative.

      Last night i inadvertantly used bad hand to open door & pain shot up my arm to elbow, boy, did I know it for the next few hours.

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