Waiting for surgery after an injury to the hand, wrist or arm

There is a delay of anything from 1-21 days between sustaining an injury undergoing any surgery that may be required. This information sheet will outline the advice for patients in the immediate aftermath of injury.

What happens next?
The on-call Orthopaedic Registrar will be informed of your problem and they will usually decide whether assessment for surgery is required. Although the Orthopaedic Registrar is an experienced doctor, they are not responsible for the final decision regarding treatment, and this decision is something that you will take with the Consultant in charge of your care.
The on-call Orthopaedic Registrar will add your name to the list of patients awaiting consultant review and surgery. This list is discussed with the Trauma team the following morning, and a plan drawn up for each case. There is a limit to the number of cases that can be done each day, and also to the availability of a specialist surgeon if required, so although we try our best to do all trauma operating as quickly as possible, it is almost never as quick as you want it to be!
The Orthopaedic Registrar will contact you by phone to let you know what is planned. If you do not hear from someone within 48 hours of your injury, then contact us on 01383 623623 extension 22441, and let us know. Remember that when the hospital call you, the number comes up as an 0800 number, and can be mistaken for a cold caller!

Pain
Broken bones (fractures) around the hand, wrist or forearm can be very painful, but this pain is usually bearable. Pain is caused by swelling around the broken bone, and this swelling is due to bleeding from the broken bone ends. Patients report that the first 2-3 days are the worst for pain, and this improves slowly over the first few weeks.
How can I help relieve pain?
Splinting – Stable fractures (fractures where the broken bone moves as one) are much more comfortable when they are kept still, and this is usually achieved with a simple splint supplied by the hospital. Unstable fractures (here the bone ends have the capacity to move relative to each other) are much more comfortable in a splint or plaster, but even this does not completely remove movement and pain.
Painkillers – Painkillers have an important role to play following an acute injury. There is a painkilling ladder used by doctors to judge which painkillers to use and when:

For most fractures, good pain relief can be obtained with a combination of painkillers from the first and second rungs of the ladder. After the first few days to a week, we expect pain to be well controlled with analgesia from the first rung only.

Swelling
Fractured bones or joints always produce swelling, from the bleeding that occurs when the injury happens. Where there is a low energy injury, such as a simple fall, this swelling is usually mild. Where the energy transfer is high, such as after coming off a bike or falling from a height, more swelling can be expected. Swelling, therefore, indicates the amount of soft tissue damage around the broken bone. There are 2 problems associated with swelling of the hand or arm after an injury:
1) Increased swelling leads to increased pain
2) Usually, a bandage or plaster slab is applied to a broken hand or arm in the Emergency Department. Where swelling occurs within a plaster, there is a risk of the plaster becoming too tight for the arm.
The general principle of reducing the amount of swelling in the hand or arm is to elevate the arm so that the broken bone is higher than the shoulder of the same arm. This is quite difficult to achieve when sitting in an armchair, but can be done by stacking pillows. A much easier way to achieve this is to lie out on a sofa, with the injured arm elevated on a couple of pillows. The arm should also be elevated in this way overnight.

Problems that we want to hear about
Tight plaster or plaster causing skin problems: A tight plaster can be easily changed or removed, and this can instantly relieve pain from swelling underneath a plaster. If you feel that your plaster is too tight, you should attend the local minor injuries unit to have this sorted – do not sit tight with this problem – if a plaster is too tight for too long, it can injure the hand.
Numbness or tingling in the hand: If the numbness or tingling has been assessed by the doctor in the Emergency Department and an explanation has been given, then we do not need to hear about it. If, however, the numbness is new or is progressing, then we want to hear about this. You should attend the local minor injuries unit and have this assessed again.
Ongoing bleeding from a wound: Most bleeding stops within a few hours, and sometimes dressings applied in the Emergency Department look a bit bloody. Bleeding which soaks through dressings is not something to put up with at home, so we recommend that you re-attend if this happens and have the dressings changed and bleeding assessed.
Infection: If you have a wound on your hand or arm, the hospital protocol states that this should be cleaned and closed in the Emergency Department if you are to return for surgery. If the surgery is to be undertaken the following morning, the wound is usually dressed without stitches. Infection is a complication of all wounds, and you should return to the minor injuries unit if you develop a temperature or notice any discharge of pus from the wound.

© Fife Hand Service 2020

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