Hand and Upper Extremity Surgery

Winter is upon us again. This time of year brings good times with family and friends indoors but also brings snow and ice.

As an Orthopedic Surgeon specializing in Hand Surgery, this means a specific subset of common winter time injuries. Of course the most common types of winter related injuries are due to slips and falls. Very frequently, this will result in bumps and bruises, but sometimes this can cause broken bones.
I will very commonly see a barrage of broken wrists when the first big snow or ice storm arrives. Obviously the best way to avoid this is to not venture out into the snow or ice, but for nearly all of us this isn't an option.

Photos: Wrist before and after a break.

The most common area fractured in the upper extremity, with slips and falls, is the radius. This is the bone in the forearm that is closest to the thumb. It will typically occur at or just below the wrist joint. Most people with this injury will initially present to an emergency department or urgent care. After x-rays are done to confirm the break, a splint or soft cast will be applied and a referral to an orthopedic surgeon will be made. Fortunately, most fractures of the end (or distal) portion of the radius are managed non-surgically. If the break is not bad, then a cast or brace will be applied for around a month. If the break is displaced (badly out of alignment), then further treatment options will be considered.

With some breaks, closed reduction can be done. This involves either local anesthetic or sedation and pushing the break back into position. If the break is so bad that it is not manageable by manipulation, then surgery is undertaken.

Photos: More wrist before and afters.

The surgery for this type of injury is outpatient, either in a surgery center or hospital. The surgery is usually done by a brachial plexus block which involved numbing the arm. The arm then stays numb for 6-12 hours. The surgery involves opening the palm part of the wrist and putting the broken pieces back into place. The pieces are then held together by a plate and screws that sit on the bone. Typically a soft splint is on for 2 weeks after surgery. After 2 weeks, a velcro splint is applied and therapy and range of motion exercises are started. Healing of the break usually takes 4-6 weeks. Total recovery time is 2-3 months.

Another injury that is characteristic to the winter is the "snowblower hand." Snowblowers are very handy tools and are very commonly used. At times when the snow is wet or thick, the blades on the blower may stick. There is a temptation to reach ones hand in to clean out snow and ice, however this can lead to injury. All snowblowers come with abundant warning labels and some even some with plastic sticks to use to clean out the blades. If the blades are stuck, there is still some torque on the blade, so what can happen is that when the blade finally is freed, the built up torque will cause the blade to advance abruptly, resulting in injury. The blade may advance even if the machine is off. These injuries are typically severe mangling injures involving fractures, tendon injuries, nerve injuries, and sometimes even loss of multiple fingers. These type of injuries can be life-changing injuries that can cause permanent loss of function.

Please be careful and safe this winter and use caution when out in the snow and ice. For more information, visit: http://www.ortholinc.com.