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.
For more information on the Penn Hand Service or
to schedule an appointment with a Penn hand surgeon,
please call 800-789-PENN (7366) or you can also
request an appointment
online.
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