BEHAVIOR
January 25, 2008

Look, Ma — No Cast!

For many of us, winter is ski or ice skating season. For orthopedists and emergency rooms, however, it is wrist fracture season.

Icy, snow-covered streets make people much more likely to slip and fall. Most of us instinctively put out our hands to break a fall, which can cause fragile wrist bones to snap on impact. Mark Cohen, an orthopedic surgeon at Chicago's Rush University Medical Center who specializes in hand, wrist and elbow surgery, treats three or four broken wrists a week in the winter, often more than four per day after an ice storm.

He has contributed to a new way to set them that allows people with wrist fractures to heal faster than ever before, and in many cases they can return to normal activities even while their fractures are healing.

In the past, someone with a broken wrist had to wear a hard cast for six to eight weeks, followed by weeks of physical therapy. Today, not only can broken wrists be fixed through minimally invasive surgical techniques, but most victims can also use their hand and wrist in a matter of days.

The change is largely due to implants known as locking plates. Newer, smaller plates designed by Dr. Cohen specifically for the wrist eliminate the need for larger incisions and allow earlier return to function. Surgeons make an incision less than 2 inches long on the palm side of the wrist. Patients wear a dressing and a splint for three to five days. Therapy begins just days after the surgery.

"In the past a wrist fracture was a terrible inconvenience. Patients had to wear a restrictive cast or external frame for six to eight weeks. They couldn't write, type, drive, or even shower," said Cohen. "With the new plating systems, patients are starting therapy within days of the surgery and most return to work within a week."

Broken wrists are more common in women than men, mostly because of age-related osteoporosis. Cohen says the best way to make it to spring without suffering a wrist fracture is eating right, exercise, vitamin and mineral supplements — and being extra-careful in the ice and snow.
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