Advances In The Treatment Of Hand And Wrist Injuries And Disorders

An injury or ailment involving your hand or wrist can severely limit your ability to perform daily activities, such as taking a shower, driving a car or using a computer, and requires an expert team of physicians, surgeons and physical and occupational therapists. The physicians of the Penn Hand Service, part of the Penn Orthopaedic Institute , provide comprehensive treatment for a wide range of issues, including arthritis, fractures, nerve problems and sports-related injuries.


As medical advances in arthroscopy and imaging techniques are used more frequently to evaluate the small bones and ligaments of the hand, the physicians of the Penn Hand Service are exploring how these advances can improve the diagnosis and treatment of hand and wrist injuries.


New Treatment Option for a Broken Wrist


A distal radius fracture, or a broken wrist, is the most common break in the arm, according to the American Academy of Orthopaedic Surgeons, and usually results from some type of trauma, such as a fall or an accident. Since older patients are prone to weak bones due to osteoporosis, this type of fracture is more difficult to repair in the older population.


The orthopaedic surgeons at the Penn Hand Service are developing new instruments and devices, such as a combination of stainless steel pins and plates, which will make it easier to repair more difficult fractures, particularly in the elderly.


"In the past, some surgeons may have used external fixation, which involves placing pins or screws into the bone on both sides of the fracture, and securing them outside the skin with clamps and rods. But we've found that internal fixation, using plates in particular, allows us to align the bones better, and patients are able to regain mobility faster," says David Steinberg, MD, associate professor of orthopaedic surgery at the University of Pennsylvania Health System.


Wrist Arthroscopy


With its small incisions, arthroscopy is increasingly being used in the treatment of the hand. Arthroscopy is a technique used to evaluate a joint for damage or disease and, if necessary, to perform surgery. Wrist arthroscopy, in particular, has proven to be extremely valuable both in diagnosis and therapy. "It is very helpful for arthritis, for example," says David Bozentka, MD, chief of the department of orthopaedic surgery at Penn Presbyterian Medical Center. "We can assess the ligaments of the wrist and examine the extent of injury, all without making any large incisions."


Penn surgeons are also using this arthroscopic technique to treat ligament injuries in the wrist and to evaluate small joints in the hand. "We've even treated some cases of basal joint arthritis (arthritis in the joint at the base of the thumb) with arthroscopy," says Dr. Steinberg.


Wrist arthroscopy is a minimally invasive surgery, which typically limits patient discomfort and allows for faster recovery. In general, the procedure is appropriate for patients with earlier stage arthritis or torn cartilage, which is better suited to this type of treatment.


"Advanced cases of arthritis, for example, require more cleaning out of bone and, in some cases, ligament reconstruction, which is better performed through open surgery," says Dr. Steinberg. Nevertheless, arthroscopy remains a good surgical option for a number of conditions, which at one time required a larger incision in the wrist.



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