hand injury roulette

April 13, 2013 12:44 PM

My friend may have broken a bone in his hand. He does not have health insurance. Would waiting until tomorrow to go for treatment potentially cause long term problems?

I know you guys hate this type of question. You are not his doctor. He is Waffling between waiting and seeing and going in tomorrow or now. A friend of ours who is a wilderness first responder had stabilized it for now. Is he risking mobility loss that will affect the rest if his life if he waits?

Also, will the emergency room or urgent care be cheaper? Thanks.

posted by geegollygosh to Health & Fitness (12 answers total)

I'm in Canada, so can't speak to the economics of your friend's predicament but the lack of updates on this earlier thread disturbs me. I think I'd go to emergency, even just for an opinion.
posted by bonobothegreat at 12:52 PM on April 13, 2013 [1 favorite]

You guys really need universal healthcare.
But, two years ago I broke my ankle, and because I walked around on it, my doctor decided it could impossibly be broken. After three months of undeclining pain, he finally sent me to x-ray, and it was still broken. A nice clean break, no signs of growing together, for better or worse. Then I finally got appropriate treatment, and today it is completely healed. The worst side effect is that it is almost impossible for me to get back into shape. But that is probably more about my age and lack of discipline.
So I guess a day won't do much difference for your friend. Still, every doctor I met said I was lucky nothing bad had developed. So he should go tomorrow. Can't say anything about economy, but I had twice x-ray, two different orthopedic specialists and 12 physiotherapy sessions when I finally got going.
posted by mumimor at 12:57 PM on April 13, 2013

URgetn care would be cheaper I think. That's why it exists - it doesn't take as much infrastructure to support an urgent care clinic as an ER, so cost of care is cheaper.

Anecdata that may be relevant: I broke my thumb once and waited about 24 hours before going in. They told me that yep, it was broken, but it begins to knit almost immediately and they'd have to force a new break to set it properly. I elected not to do that. I now have occasional pain in the thumb and a loss of range of motion, and it took ages to heal. Wish I'd just have gone in when I first did it.
posted by Miko at 12:57 PM on April 13, 2013

I broke my hand and, though I saw a doctor immediately, I waited a day for surgery (not by my choice, it was just timing issues -- I broke it Sunday afternoon, and possibly Easter Sunday). I lost a lot of use of my hand, and had constant pain until I had a second surgery, which got rid of even more use, but went down to tolerable levels of pain most of the time.

This was my right hand, and I am right-handed.
posted by jeather at 12:59 PM on April 13, 2013

I am not a doctor but am typing this with a broken wrist, good insurance, and a substantial ER bill.

Unless the fracture is badly displaced and will damage blood vessels or nerves, it's the least urgent part. The fact that it's stabilized (and iced and elevated, right ?) is very good, and any surgical intervention would happen in a few days after swelling subsides a little.

In my case, my arm was hanging at an angle and I was going into shock, so I chose E.R.

If ice, ibuprofen, and stabilization are working, I say go to an urgent care clinic. They are significantly less expensive than an Emergency Department visit and you might actually get care faster; in an E.R. an enclosed fracture is fairly low on the triage list.

If swelling is very extensive, pain is significant, or your friend is experiencing shock symptoms, then go to the E.R. Search MetaFilter later for negotiating strategies with their billing department.
posted by Kakkerlak at 1:05 PM on April 13, 2013

I've broken my hands a bunch (long story.) Some of the fractures have been tended to immediately, some have gone several days before being cast and some were never cast at all. If the fractured bone is not displaced, I'd say he can wait.

My only concern would be if the broken bone were the scaphoid, which has poor blood flow and a high rate of nonunion fractures even with medical care. If a scaphoid fracture is suspected (test by pressing on the snuffbox) make a splint that will immobilize the hand in a neutral position until he can get it checked.
posted by workerant at 1:11 PM on April 13, 2013 [1 favorite]

I've had fractures in one hand and both feet. When I went to the ER, they stabilized it, prescribed ice, ibuprofen, and elevation, and told me to try to get in to the orthopedic surgeon's office the next day.
posted by The Underpants Monster at 1:19 PM on April 13, 2013

I broke my ankle a few years ago -- couldn't walk at all, was in a lot of pain whenever I moved my leg. I went to the emergency room, where they x-rayed it to confirm it was broken, stabilized it with what was basically a large Ace bandage, gave me some aspirin, told me to stay off it, and sent me home with a prescription for some weak vicodin and a recommendation to an orthopedic specialist to have it set properly sometime that week. That emergency room visit cost me about $2500.

They didn't give me a cast or set the bone in any way; that was done at the specialist's office a few days later. The specialist's office repeated the entire diagnostic procedure the emergency room had done.

YMMV.
posted by erst at 1:21 PM on April 13, 2013

Erst, it wasn't just an ace wrap, I can almost guarantee it was a splint. A splint immobilizes the joint/bones in question. A splint is a very acceptable temporizing measure until a cast can be placed, and in many cases it is preferable to splint first until the swelling has reduced, because casts cannot be adjusted to a different size, they are fixed at the size they are placed at and if swelling worsens while you are in a cast, it can cause pain and other complications. Deciding on what type of splint and how to place it require professional training, and that is what cost you the money. Also, Vicodin is a strong narcotic pain reliever, just because you did not feel that it was enough to address your pain does not mean that Vicodin is weak.
posted by treehorn+bunny at 1:30 PM on April 13, 2013 [2 favorites]

Previously. The answers there suggest waiting would be okay.
posted by purpleclover at 3:00 PM on April 13, 2013

I ran the symptoms through the BC healthlink wizard for hand injuries and it says seek medical attention (though a doctor of any sort is fine, it's not a ER Now level problem unless that is the only option) as soon as possible though I had to guess at some of the answers. The diagnosic and advice wizard is free so your friend might want to run it and see what it says.

PS: from what the wizard asked me you haven't provided enough information for even a health professional to reasonably make a recommendation on the need for treatment.
posted by Mitheral at 3:25 PM on April 13, 2013

Response by poster: Thanks everyone, we ended up at the er because he was in a ton of pain from rib injuries as well as the hand and urgent care needed upfront payment in full. Hooray for the American health system. Anyway, as it turned out nothing is broken so he wishes he had waited but is relieved overall.
posted by geegollygosh at 7:54 PM on April 13, 2013