Snap, Crackle, Pop!

Today I was seeing a patient who fell out of her wheelchair and hurt her wrist. The xrays showed a displaced distal radial fracture (a fracture in the thumb side of the wrist that wasn't lined up.) Like usual the doctor came in the room to see the patient after I had seen her. He decided that since she was old (81 years) that she didn't need to have it surgically plated. This meant that we were going to have to manually reduced the fracture in the office. I was standing back watching and he looked at me and said that this was my patient so I needed to fix her. I was kind of shocked and questioned him but quickly jumped at the chance to do this. I have seen closed reductions before but nobody has ever let me do it. I'm going to explain how this is done so be prepared for a little bit of brutalness.

The first thing you have to do is to determine exactly where the fracture is using both the xray and touch. Once you figure that out you have to numb the area with zylocaine using a technique called a hematoma block. That is exactly what it sounds like, you put the needle directly into the hematoma inside the broken bone. It amazes me how little the patient's react to this because it looks excruciating! You then let them sit for a little bit to let the numbing agent set in. Once it is numb you grasp the wrist below the fracture with one hand and grasp above the fracture with your other hand. You then pull the fracture apart and pull the bottom of the wrist in the direction of the fracture. While doing that you push the hand down as hard as you can and it should slide into place. I was surprised at how much force this took. The sound and feeling of her bone moving was disgusting! Generally I love gruesome surgery/injury stuff but this actually turned my stomach and made me a little nauseous. In fact just thinking about it makes me nauseous.

I still cannot believe he let me do that!! While I am grateful for the opportunity to have been allowed to reduce the fracture part of me hopes I don't have to do it very often. Gross...