Why didn't doc set broken hand?

[Bwildered]

A tall story, so to speak.

 

[holeycow]

Went over the bars on a little kicker in a race. Dislocated my shoulder and had a concussion. My shoulder had popped out and went back in on its own when trying to move it a bit in the pits. It hurt.

Went to the local hospital to get checked out. The fat **** lazy doctor finally acquiesced to giving an xray. I held a bleach bottle about a third full of water for the xray. It was no weight at all. Anyway, fat **** said nothing happened, nothing is wrong. When I objected mildly, he grabbed my arm and lifted it harshly causing my clavicle to pop straight up about 2". His eyes went wide! NOW it was severely hurt.Idiot. Anyway, then he put my arm in a loose sling (which failed about 15 minutes out of the hospital, btw as it was so poorly made with the triangle bandage). One of my buddies had to fix it.

A short time later I was watching a football game where a player took a hit and popped his shoulder. The trainer came on to the field and set it and taped it up before the guy even had a chance to stand up. Tape over the top and around the upper arm to the chest and back, effectively immobilizing the arm, That's what fat **** should have done, not just given me a sling allowing my arm to flop around. At that point I knew what should have been done.

To this day I have trouble with that shoulder from time to time. Occasional pain and mobility issues. No big deal, but annoying.
Just because they are a doctor does not mean they have any aptitude for the trade whatsoever. Doctor school candidates are chosen almost solely on their grades in science class.

Not all doctors are worthless, not by a long shot, but many are. Most are just legal drug pushers.

I have other stories as most of us do, I bet.

 

[sirbuildalot]

I broke my hand punching a wall instead of my father when I was 19. They didn't reset anything. Put it in a cast and cut the cast off several weeks later. Still have a big bump on that hand. Wish I'd of gone to a specialist. Here we are 20 years later and I still look at that hand form time to time and think WHY!!!

Go see the specialist

 

[Blue42]

Dang guys. Well it has been a long story since I last updated. I appreciate all your stories.
I went to an orthopedist five days after I broke it. He said I was going to need a plate to hold it straight. He went out of the room to schedule the surgery then came back and said he talked to the hand specialist who said I would probably be fine just putting a splint on it. They sent me off to get the splint and I was expecting to talk to a doctor who would tell me something. Instead a kid in his twenties slapped the splint on my hand (after taking direction from me of where the break was and based on my interpretation of how the splint was supposed to work). He told me nothing whatsoever except to take it off when I showered. Then they wanted me out the door, and to come back in 4 weeks.
I asked to talk to the doctor again. He was irritable and very busy and he told me you don't have to be precise at all with how you put the splint on. Then I was hustled out the door.
The next day I went and got a second opinion. He also said it would be fine. This was all pretty funny to me given that the X-ray showed it to be crooked as heck. I had also read the instructions on the splint the day that I got home and saw that they didn't follow them.
After seeing the second doctor I called the first office again to get an appointment with the hand specialist. They told me he was busy until January.
I got more X-rays of my hand with the splint on it (which you would presumably expect to be holding the bone straight). It wasn't straight at all. See picture below. So I printed out the xray and walked into the office and told them "this can't be good."
2 days later I had an appointment with the hand specialist. He told me the splint was on wrong. And I learned that apparently it had also been on too tight and that the red mark on my hand was indicating that the tissue was dying from the inside out because of the sharp bone underneath and the splint being on too tight over that. So thanks so much to them for that great first visit.
It should be fine now, although it is still crooked as heck and displaced 50%. Apparently your hand can heal pretty good in the 4th and 5th metacarpal even if they are crooked. Not as much on the 1st and 2nd. They'll probably put hardware on those to keep them straight. But I certainly don't trust doctors to put any time or thought into anybody's particular case.
I think the hand guy is a good doctor, as does everybody else down here in this area, but he has been wrong twice already too. At the first visit he ordered me to take the splint off entirely so that hopefully I wouldn't need surgery carving off dead tissue and grafting on new stuff. I went back to him a second time and the bone had slipped further out of place. As the visit concluded he said to tape it again in a buddy splint (one finger to another). I asked about which finger it should be taped to and he thought about it for a second and then instructed me to tape it to the opposite one as he had before, which I had thought all along would have been better. When I got home after the first visit with him I had pulled off the tape he did and taped it to the other finger as soon as I got home because it made more sense to me for straightening it out. But then I thought, "well, he is a doctor and he might know better." Well, he would know better if he had put any thought into it. But he didn't put any thought into it.
I also asked on the second visit about putting the splint on a different spot, next to the break instead of right on top of it. He said it wouldn't work unless you could put it right on top of the fracture. Well I'm afraid that's just not true. So I'm wearing the splint.

And by the way, the second opinion doctor didn't even look to see if the splint was on correctly, so there was another failure.
So this whole thing reinforces what you guys said, and I already believed myself as well. Watch out for yourself because the doctors can be negligent and they aren't putting a whole lot of care and thought into your case. Don't just trust any authority if what they say doesn't make sense or if you suspect they haven't even thought it through.

 

[Blue42]

And about setting the bone: the first doctor's squeezed my hand and you could hear the bone crackling around. But it didn't stay put. Then they slapped on the splint. After I got home and realized just quite how badly they had done, I took treatment of it into my own hands....or, hand rather.
I figured the thing was supposed to be set straight, then the splint held it straight, like the directions said. The directions also said to take an x-ray after the splint was put on to make sure the fracture was "reduced," meaning set good.
None of that was done so I started pulling and squeezing on the bone moving it around myself. Then I strapped the splint on where I thought it should go, hoping it would be pretty straight in there inside my big swollen pig sausage hand.
Well apparently with my fracture ( and I think with pretty much any fracture of a metacarpal bone) you just aren't going to be able to set it straight and keep it straight unless you put some hardware on it; meaning surgery. So my hand right now looks just like in the picture. Actually a little worse since the bone had slipped the week I had the brace off.
I did modify the brace with aluminum plates two weeks ago trying to make the splint better. And it was much better. The freaking thing doesn't fit too great and there is no way to hold it where its supposed to go the way it was. I was in the garage for 6 hrs, with one hand, until 1230 am doing it.

If I could put a freaking wood clamp on it to get it straight I would. Only problem is that the soft tissue can't take the force. So if you bust your hand, you probably have the choice of surgery or a big bone bump on the back of your hand. Not much else to be done I think. Unless your break is different from mine. On mine some of the bone was pulverized I think, so the edges don't fit together good.

 

[xraydaniel]

Sorry to hear about your predicament Blue42. I am just seeing this post now after a long hiatus from arborsite, lolz. I do this stuff for a living, that is, radiography for a major Boston hospital.

As you already know now standard course of care would be xrays, reduction, splint, and surgery if reduction is not good enough. Wrt to long bones and major joints there is a greater probability of long term damage if not addressed quickly.

Metacarpals, metatarsals and other mostly static bones can have some distortion and you will love a long healthy life. You can’t really reduce those fx’s well as there are other fixed bone positions around the spot. You can press and twist a bit to get it in a better position but sometimes you need surgical intervention

I would like to see the lateral view to better assess distraction of the proximal and distal pieces. It looks like the surgery was indeed called for looking at that AP view. Urgent care centers are for quick and dirty fixes and if evident a transfer to a major hospital is warranted.

That being said, since I’ve been doing this for over 20 years I’ve learned you have “shop” smart with your healthcare when you can since there are a lot of MD’s out there still learning or not specialized as well as mid-level practitioners taking the frontline.

Tissue necrosis is a serious thing. I would make sure that is addressed pronto. A small liss plate with 5-6 screws would do well to fix that fx.

 

[kyle1!]

Go see another specialist because that needs some surgery/pin inserted because the bones are not aligned. That is not a clean break that would just require a splint to keep it aligned while it healed. That xray looks like my foot did 30 years ago. I broke 3 bones in the middle of my foot playing basketball.

 

[Blue42]

Sorry to hear about your predicament Blue42. I am just seeing this post now after a long hiatus from arborsite, lolz. I do this stuff for a living, that is, radiography for a major Boston hospital.

As you already know now standard course of care would be xrays, reduction, splint, and surgery if reduction is not good enough. Wrt to long bones and major joints there is a greater probability of long term damage if not addressed quickly.

Metacarpals, metatarsals and other mostly static bones can have some distortion and you will love a long healthy life. You can’t really reduce those fx’s well as there are other fixed bone positions around the spot. You can press and twist a bit to get it in a better position but sometimes you need surgical intervention

I would like to see the lateral view to better assess distraction of the proximal and distal pieces. It looks like the surgery was indeed called for looking at that AP view. Urgent care centers are for quick and dirty fixes and if evident a transfer to a major hospital is warranted.

That being said, since I’ve been doing this for over 20 years I’ve learned you have “shop” smart with your healthcare when you can since there are a lot of MD’s out there still learning or not specialized as well as mid-level practitioners taking the frontline.

Tissue necrosis is a serious thing. I would make sure that is addressed pronto. A small liss plate with 5-6 screws would do well to fix that fx.

A radiologist! There are all kinds of benefits of the arborist forum. The other two shots are below Dan.
At this point they'd have to hit it with a hammer to move it. It isn't crackling around anymore when I push on it. Or I could do it in my garage. I wish I could get another shot at it myself with a decent brace. I bet I could have gotten it to heal a lot straighter.

 

[miller755]

The medical profession truly makes me sick. Any successful trades-person has to guarantee their work, and own it when they make a mistake. Doctors and surgeons make you sign release waivers, and just pay for malpractice insurance. Like anyone can see from the X-ray, your bone is misaligned, sure the doctor say it will be fine(and i am sure it will be fine, humans are pretty rugged creatures), but will it be optimal? Would he have left his child's hand like that? Doubtful. They need to spend more time teaching accountability, in institutions of higher education.

 

[Volund]

Funny question for the arboristsite but someone I hope will know. I broke my hand it today punching something. The fourth metacarpal broke all the way through. I went to Urgent Care and they put a makeshift cast on it but the nurse practitioner didn't even try to get the bones aligned. The X-ray showed that the bone was not aligned at all. I asked if it was worth trying to align the bones and he said it was not worth it and that the tendons and muscles would pull the bones back into place. Does anyone have any experience with this? I could freaking pull the bone out myself and get it straighter than it was on the X-ray. When I first broke it I actually moved it into a better place than it was originally.
It concerns me just letting the thing sit and maybe heal up all crooked when a simple pull and set might have gotten it much better.
I have to go to an orthopedist next week and I'm sure he'll do what needs to be done. But I just wonder why the heck in the meantime we would just let it sit crooked. I'm kind of suspecting the Urgent Care place just wanted to patch it up and pass the buck on to the orthopedist.

Ive just cut the string to my thumb 9 weeks ago, Im sharpening everything. 12 weeks I may apply full load.
Its grown alright, limited motion. She said the pain will last 6 monts to a year - constantly doing the stretching and exersises. It hurts every time every hour.
It will stiffen up and get like imobility if I dont exersise in 3 hours, better get movin.

 

[xraydaniel]

A radiologist! There are all kinds of benefits of the arborist forum. The other two shots are below Dan.
At this point they'd have to hit it with a hammer to move it. It isn't crackling around anymore when I push on it. Or I could do it in my garage. I wish I could get another shot at it myself with a decent brace. I bet I could have gotten it to heal a lot straighter.

At this point just deal with it as bone will grow around the site creating a solid mass over time. That first pic you added in your post a few weeks ago was the oblique view. The views you added do show some displacement though not severe. Again, be wary of your skin condition and don’t keep compression on too long. Will surgery help or hurt at this point? IDK. The Ortho surgeon would dissect down to bone and put a plate in with about 6 screws. It would straighten that metacarpal out but you gotta make that decision. Most important decision is to mitigate pain and discomfort but if you feel better and pain subsides with time leave it be. You will be fine going forward as the fx does not involve a joint space. When a fx compromises a joint space you will most definitely have osteoarthritis in the future. Those fx’s cannot be ignored. I had a spiral fx of my tibia years and years ago. Didn’t need ORIF and there is a large growth of bone mass around the site after I checked it with imaging about 6 years later.

 

[Blue42]

Thanks Dan. Well, it stinks. It healed like this. A fairly substantial deformation I would say. It's just hard for me to believe we can't do a little better than this without surgery. It's as bad and worse than the pictures capture. The finger is pretty crooked now too when I close my hand.
I'm contemplating going back in for one more visit just to show them the final product and see his face and what he says.

 

[xraydaniel]

How does it feel to make a fist and also to outstretch your fingers?