How can I convince an orthopedist to give me the type of cast I want?

November 5, 2011 9:41 PM

I broke the wrist on my right (dominant) hand. How can I convince an orthopedist to give me the type of cast I want?

I broke the tip of my ulna a couple days ago. The fracture is not displaced but does somehow invade the wrist joint space. I have a temporary splint they applied at the ER (that I've begun removing to type and prepare meals, against medical advice). I live alone, am on disability for mental illness, have no support system or friends to speak of, and am poor. I make my Christmas presents--knitting socks and scarves and sweaters, mostly. I also do a lot of typing and mousing and painting with a Wacom tablet. Just two days of wearing a splint that totally prevents all finger, wrist, and hand movement has almost driven me (even more) insane. I can't make coffee, prepare proper meals, type, or even drive effectively, much less engage in the few activities I use to deal with my severe mental problems. I am now constantly on the edge of tears. The thought of several weeks of this is pretty much unbearable.

How can I convince the orthopedist I must make an appointment with on Monday to give me some type of functional cast that allows for wrist and finger flexion? If this isn't possible, would it be completely crazy to treat my own broken wrist with a functional brace that I wear most of the time? I don't have much of a compass for taking care of myself, so I can't really tell if it's worse to be completely mentally and physically dysfunctional for 6 to 8 weeks or to possibly suffer an improperly healed fracture.

Opinions?

posted by xyzzy to health & fitness (20 answers total)

To treat a fracture properly, you have to immobilize the joint in question. So if you've broken your wrist, your wrist is not going to heal right if you are flexing and extending it - the point of the splint/cast is to immobilize it. And if your wrist doesn't heal right, you are going to struggle with not being able to do the things you love for a lot longer.

Your fingers don't need to be immobilized if the only fracture is in your wrist. You probably wouldn't get a cast that would immobilize your fingers anyway, but just emphasize to your orthopedist what you've said here, and that you want to have as much mobility as you can while still allowing your wrist to heal well.
posted by treehorn+bunny at 9:51 PM on November 5, 2011

Disclaimer: I have never broken my wrist, but I have had my fair share of injuries in the past few years.


YES IT IS COMPLETELY CRAZY TO TREAT YOUR BROKEN WRIST.

Just grit your teeth through the next 6-8 weeks of being dysfunctional. Do not do things that could make the injury worse because then you're looking at an even longer period of healing and all the mental agonizing of, "Why didn't I just heed the doctor the first time around?" on top of more dysfunction.

I tried treating my own tendinitis in my foot a bit and waited a month before seeing a doctor. That landed me about 10 weeks + physical therapy and then I immediately had a small relapse the week later. I ended up being put in a walking boot that limited a lot of my normal activity as I engage in lots of physical activities and sports.

I really can't offer any advice about how to deal with such dysfunction. I quite honestly have been an absolutely awful human being these past few months. I guess just try not to get too bitter about it and keep in mind that you will eventually heal.
posted by astapasta24 at 9:54 PM on November 5, 2011

I have had to wear a cast on my dominant hand that eliminated usage of my thumb. It does suck, but you tend to find other ways of doing things with your off-hand, as well as some ingenuity with tools (chopsticks shoved down the cast were useful in several ways). On my worst days, not having an opposable thumb made me feel subhuman, but it was only a temporary situation, and I've healed properly.

Please do not try to treat this yourself. There's a reason your doctor wants your hand immobilized. Just keep reminding yourself that it is a temporary situation!
posted by blurker at 10:04 PM on November 5, 2011

Um, what? Don't you think it's better to suffer 8 weeks than it is for the rest of your life? Messing with it and trying to treat it yourself could have negative permanent effects. Now is a time to learn a great skill...using your non dominant hand. Yeah it sucks and is really awkward at first, but you learn a lot faster than you think you will.
posted by MaryDellamorte at 10:06 PM on November 5, 2011

My mother in law had a similar fracture in her foot, and she blew off getting it treated for weeks until her whole leg was swollen and she was in agony. It's four years later now, and she still has problems with it. It's drastically affected her enjoyment and ability of many of her favorite activities. If you need to work with your hands to stay sane, you MUST do everything you can to allow your wrist to heal.
posted by KathrynT at 10:16 PM on November 5, 2011

*sigh* The thought of giving IOUs for Christmas and being continually frustrated and angry is very disheartening, but I suppose y'all are right. I'm just really really bad at making these kinds of decisions, mostly because I don't care about myself, which makes me do stupid things.
posted by xyzzy at 10:29 PM on November 5, 2011

I just checked out your website with your knitting and you have an amazing talent (holy shit those doilies!). I can see how it would be hard to give that up for almost 8 weeks but if that's the stuff you're giving out to friends and family, it's definitely worth waiting for until after Christmas. They will understand. You want to keep your wrist happy and healthy for many, many years of awesome knitting adventures.
posted by MaryDellamorte at 10:37 PM on November 5, 2011 [3 favorites]

On more data point: I broke my arm quite badly as a kid (ulna and radius both); the breaks weren't set properly and the cast didn't fit right. The ulna (I think) healed improperly, and I couldn't pronate my wrist; I had to have surgery where the bone was rebroken, and set with a pin and screws. Then a year later, the pin had to come out (I was still growing and the site was near a growth plate). The whole process was a giant pain.

So! Listen to your ortho - short term grrrr is a much better deal than lifelong grrrr. Good luck, and be kind to yourself.
posted by rtha at 10:41 PM on November 5, 2011

No one is going to think twice about not getting Christmas presents from you this year given your injury. Please worry about healing yourself and not about what you can or can't give others.
posted by crankylex at 11:01 PM on November 5, 2011 [1 favorite]

Please take proper care of your wrist - it's much more disabling if it's not treated correctly in the first place.

For perspective, I would be utterly horrified if someone I knew prioritized making me a handmade gift over treating their broken bones! I could never look at the gift without feeling horrible. Please don't do this to yourself or your friends.
posted by Space Kitty at 12:08 AM on November 6, 2011 [1 favorite]

I fell of a scaffold and cracked the end of one of the bones in my right elbow; to ensure healing they put a cast from right at my shoulder all the way down to my damn fingers, my arm at a 90 degree and my hand turned 'out' and opened flat IE as if I was asking you for some change, palm up, my thumb stuck straight out so as I could have poked you with it.

I was at that time totally about work, it was the only worth I thought I had; it tore me up to have to not be able to work. Plus, the same day it happened the woman I was living with waved me goodbye. It was A Bad Day. So now I can't work and I've got all the time in the world to think about love gone south. I was sure happy.

I absolutely understand, one hundred percent, what you're up to here. I really wanted to cut the thing off at least enough so I'd have use of my hand/fingers -- I could just move the ends of my fingers, like enough to wave goodbye at my now-ex with the top joints of my fingers; my life was like living in a damn cartoon -- but the doc told me that if I wanted to use my elbow the rest of my life I'd have to calm down.

I wanted to bite myself. Or him.

Totally annoying.

But I have total use of that arm today, 27 years later -- I turn my arms down and open them up and you cannot see the difference, they both extend the exact same. The doctor told me that wouldn't happen, or for sure there was a very good chance that it wouldn't happen, that I'd be limited to whatever degree. I'm not.

This is a good time for you to learn to relax. Get all reflective and shit. Maybe start a meditation practice and no, that I am not kidding about -- if it's ever held any interest out to you, well, since you've got to sit still anyways...

Good luck.

I went to your site, too -- beautiful stuff. I'll buy a pair of socks from you -- I like the gray and blue ones -- if you wait to make them until after you're all okay.
posted by dancestoblue at 12:29 AM on November 6, 2011 [1 favorite]

I have broken both of my wrists. Had a cast on each of them too. I would ask for a fiberglass cast with a gore-tex liner so that it is lighter than plaster and can get wet (although do what you can to prevent it from getting wet). My fingers were free to move about no worries. Within about a week or two, my wrists had atrophied or lost weight such that I could flex them a little bit. I also took off my plaster cast myself a week early as it was just too much and my wrist felt fine. I have also actually put two stitches in my forearm with a regular needle and thread as I had no way to get to emergency room until two days later (weather related issues prevented travel). Hurt like hell going in, but worked pretty well. So well, they left them in for two additional days before removing them and putting on a butterfly to hold the scabbed wound closed.

Having said all that, I would not try to treat yourself. I would ask Dr for most aggressive treatment. If that is immobilization then live with it. Ask for electric stimulation and anything else that might help speed up or help the healing process. 4 weeks of suckiness now sure beats a lifetime of aches and pain. (I never got treatment for a broken pinky and it is now in a locked position partially bent. It hurts in humid weather too.)

I also think that with a cast on, and no way for you to take it off without getting the old dremel fired up, you will learn to adapt to the limitations. I bet that you can knit, although I would also bet you will be about a 1/3 as fast.
posted by JohnnyGunn at 1:16 AM on November 6, 2011

Fellow knitter! I, too, have suffered from the need to immobilize one of my wrists, and also use knitting as a way to deal with mental health issues.

A couple suggestions of things that might help... First, if you don't knit continental, now would be an excellent time to learn. Yes, there's a learning curve and yes, it's frustrating, but for me, any knitting was better than no knitting, and now I knit continental all the time and can't imagine doing it any other way. Because both the yarn and the active needle are managed by the left hand, the right hand's movements are very, very limited, and if can close your hand around the needle, you can probably manage.

Second, if you prefer to do socks on DPNs, you might want to consider looking into getting a knitting sheath, also called a knitting stick. They were very popular back in ye olden times, and take almost all the stress of knitting off of your wrists. There are reasonably good explanations and videos here. If you combine this with continental knitting, your right hand can be completely left out of the process.

There are a number of videos on YouTube about various techniques to knit one-handed--searching for it will bring up many more videos than I can link here. Good luck.
posted by MeghanC at 1:32 AM on November 6, 2011 [5 favorites]

If you are having trouble preparing meals, you could try Meals on Wheels.

You worry about the people who you want to make presents for, could any of those people help while you are recovering? I had back surgery a couple of years ago and didn't want to bother anyone, so I tried to take care of myself. Many people that I never would have asked for help happily offered when they saw I needed it. The worst thing that could happen is that they aren't able to help, so you could try asking. Small things like helping carry things, help with shopping, bringing over dinner one day are tasks that those people could take on. Every grocery store does carry out service, which is great. I used to feel awkward asking for it but it has been a life saver.

Instant coffee isn't the best, but maybe it is a good shortcut for now?

Please take care of yourself and try to follow doctor's orders. Better to fix it right the first time instead of lengthening your down time by fiddling with it.
posted by dottiechang at 1:14 AM on November 6, 2011

Youtube has lots of one handed knitting, and even better, crocheting videos. The added concentration it's might take to work like this is possibly going to be even better as a coping strategy, really let you get in the zone.
posted by Iteki at 4:32 AM on November 6, 2011

You should be fine. What you are describing is a fracture of the Ulnar Styloid (although without looking at an X-ray I can't confirm it 100%) If the fracture is toward the distal end or tip, then treament often doesn't even involve a cast, but more often a supportive wrist splint that will immobilise the wrist to reduce discomfort, but still allow normal hand function (see this one) and you'll probably only need to wear it for 3-4 weeks.

If you do need a cast and it is applied properly you should still have the full ability to grip and perform fine motor tasks as the cast should only come to the level of the palmar crease and the thumb doesn't need to be immobilised allowing full function of all your fingers.

I'm an ED Nurse Practitioner and my older patients with casts for wrist fractures (even more complex distal radius fractures) always seem to manage their knitting, and the young kids always manage to continue using their computers and video game consoles.

It sounds to me that whoever applied your splint in the ED was probably inexperienced at casting and just didn't do a great job. I'm sure when you see to the Orthopaedic specialist everything will work out fine.
posted by mule at 5:01 AM on November 6, 2011 [1 favorite]

Guy in my gym broke his wrist playing soccer. It wasn't that bad of a break. But he didn't want to deal with a cast, so he didn't get it immobilized straight off the bat, kind of played around with putting his arm in a splint and avoiding using it as much as possible (while still trying to use it when he needed to).

The end result of the story is it got a lot worse. It's a year later and he only just got the cast off he had put on when it was clear his self-healing methods wouldn't work. He ended up needing additional surgery on it and he was wearing the cast for six months as opposed to the 6-8 weeks his mild break would have initially required.
posted by schroedinger at 7:34 AM on November 6, 2011

Quit contravening the medical advice you've been given, allow the orthopedist to put you in whatever immobiliser they think will give you best healing results, and be patient for the process to complete.

Which is what everyone else said, but I think repetition might help you.

I'm sorry you don't care very much about yourself. I hope that's something you're seeking some help on, independently. You make very beautiful things and clearly have love in your heart for others. It would be beautiful if you could have love in your heart for yourself, too. You wouldn't want someone you loved to hurt themselves to give you something in a certain timeframe, I'm sure.

I can add to the anecdotes about not letting broken wrists heal properly, too - I broke my right wrist twice and didn't follow the instructions for rest and did everything I could to make the casts (half cast first time, full cast second) give me more movement. Stupid. So stupid. I probably would have ended up with the osteo-arthritis anyway because of the multiple breaks, but the weakness and glitchiness are directly because I didn't follow instructions. I drop things unexpectedly, my wrist/hand tire too soon for so many of the activities I enjoy, and even writing longhand is a pain. B'bye calligraphy :(

May your wrist heal well and quickly!
posted by batmonkey at 8:19 AM on November 6, 2011

I just wanted to thank everyone for their thoughtful responses and suggestions. (And kind words about my little knitting projects.) I'm going to the ortho tomorrow and I'll do what s/he says. I do have a tendency to expect the worst, so maybe I'll be pleasantly surprised. :)

I do feel a little better about this situation, and I'm glad I asked y'all for your thoughts.
posted by xyzzy at 9:07 AM on November 6, 2011 [1 favorite]

From Ms. Vegetable:
I, like another poster, was in a full wrist brace on my dominant hand, thumb immobile, no bending no using whatsoever, for about 3 months. I HIGHLY recommend a "knitting loom" - you can hold the loom with your casted arm, and use your other hand to do the loops. I did this so much that it feels backwards to me now to switch to doing the loops with my dominant hand. This got me through my crafting needs.
Good luck. I know this sucks.
posted by a robot made out of meat at 12:39 PM on November 6, 2011