What Is Complex Upper Extremity Fracture Surgery?
The upper extremity is your arm from the shoulder to the fingertips. A fracture is a broken bone. Many fractures in this area heal well with a cast, splint or sling. A fracture is called complex when the bone is broken into several pieces, the pieces have shifted out of place, the break runs into a joint surface, or the bone has broken through the skin.
Fracture surgery puts the pieces back in position (reduction) and holds them steady while the bone heals (fixation). Depending on the bone and the break, the surgeon may use:
- Plates and screws: a thin metal plate fastened to the bone with screws, often used for wrist (distal radius), forearm, elbow and upper arm fractures.
- Screws alone: for example, a single screw across a scaphoid fracture, a break in a small wrist bone near the base of the thumb.
- Pins or wires: thin metal pins placed through the skin or through a small incision, often used for finger and hand fractures.
- Joint replacement: for some complex fractures in older adults, replacing the joint may work better than rebuilding it, for example a reverse shoulder replacement for some upper arm fractures near the shoulder, or an elbow replacement for some fractures near the elbow.
Performed at a hospital or surgery center where our surgeons operate, with evaluation, X-ray, follow-up visits and hand therapy here in our Boynton Beach office.
Who Is a Candidate?
Not every broken bone needs surgery. Dr. Tucker looks at where the break is, how far the pieces have moved, your bone quality, and your work and activities. Surgery is more likely to be recommended when:
- The bone pieces are badly out of place or cannot be held in a good position with a cast.
- The break extends into a joint, where small steps in the joint surface can lead to arthritis later.
- The fracture is unstable, meaning it is likely to slip out of place as it heals.
- The bone has broken through the skin (an open fracture).
- A scaphoid fracture has shifted or has not healed, since this bone has a limited blood supply.
- Nerves, blood vessels or tendons are also injured.
When a cast or splint is a reasonable choice, Dr. Tucker will recommend it, with close follow-up X-rays to make sure the bone stays in place.
What to Expect
Your evaluation includes an exam and X-rays in our Boynton Beach office. Some fractures also need an MRI, which can show breaks that are hard to see on X-ray, such as some scaphoid fractures. Dr. Tucker explains whether surgery or a cast fits your fracture and what each path involves.
Surgery is done at a hospital or surgery center where our surgeons operate. Many hand and wrist fractures are repaired as an outpatient procedure, and you go home the same day. Anesthesia may be general anesthesia, a nerve block that numbs the arm, or both. Larger fractures of the elbow or upper arm, and joint replacement for fracture, may involve a hospital stay. You will leave with a splint, dressing or sling.
Risks and Side Effects
Fracture surgery carries risks. These include infection, stiffness, nerve or blood vessel injury, tendon irritation from plates or screws, bone that heals slowly or does not heal (nonunion), bone that heals out of position (malunion), and risks from anesthesia or the nerve block. Joint replacement for a fracture adds the risks of the implant, such as loosening or wear over time. Dr. Tucker will explain the risks that apply to your fracture.
Recovery
Recovery depends on the bone and the repair. Bones in the hand and wrist often take about six to eight weeks to heal enough for light use, and larger bones and joint injuries can take longer. Stiffness is common, so early guided motion matters when the repair allows it.
Dr. Tucker coordinates hand and occupational therapy in our office. Our therapists, including Elise Burger, OTR, can make custom splints, guide motion and strengthening, and help you return to work and daily tasks. They share your chart with Dr. Tucker, so therapy matches how your bone is healing. Follow-up X-rays in our office track healing.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Fracture care and fracture surgery are usually covered by Medicare and most commercial PPO plans when medically necessary. Planned surgery often needs prior authorization. HMO and managed-care plans require a referral from your primary care physician before your visit. Co-pays, co-insurance and deductibles apply. If you were hurt at work, we accept workers' compensation and coordinate treatment, documentation and return-to-work planning. Call our office to verify your benefits.
When to Talk to a Specialist
Go to the emergency room or call 911 right away if your arm, wrist or hand looks deformed, bone has come through the skin, or your hand or fingers are numb, cold or pale. For a suspected fracture without those signs, call our office to be seen promptly. Some fractures can look like a sprain, so have wrist pain after a fall checked if it has not improved within a few days. After surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision. For other questions after hours, call our main office number to reach the answering service.
