Word: wrists
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...took the kids ice skating... fell pretty hard. They told her it's a bad break. Would you mind taking a look at the x-rays? I'm attaching them. It's the right wrist...
...wrist in question belonged to Carol, a super-busy young mom, married to Peter, one of my best buds from college. Late-spawning academic types, they live in a city of world-famous hospitals. The picture with the e-mail was a familiar x-ray to every orthopedist. Carol's wrist was sporting a nasty fracture of the distal radius - the larger of the two long bones in the forearm, just at the joint. The bone was in a few pieces (the fracture was "comminuted"), and it broke into the joint (it was "intra-articular") but none of the pieces...
...right up to the Clinton years, we've treated fractures like Carol's with closed reduction and casting. "Treating it closed" meant we set it ("reduced the fracture"), i.e. pulled and twisted (hopefully with some anesthesia) to get the pieces into the best position possible, then we held the wrist still in a plaster cast for a month and a half - 40 days and 40 nights being the magic healing time for most things orthopedic. Done well (and soon) closed reduction works quite well; an experienced orthopedist with good hands can take some horrible-looking fractures and usually...
...when any surgery meant great pain and usually an infection, closed treatment was the only sensible option. A good closed reduction still makes any bone doctor worth his salt proud. Walk up to some poor guy looking forward to a life of pain, deformity and stiffness, pick up his wrist, give it just the right yank and wham! he's cured. Makes you feel like Fonzi kicking the Coke machine. (See TIME's special report "How to Live 100 Years...
...there is also a surgical approach to fixing a broken wrist; it's had its place for decades. It was always a judgment call though: back in the day we sometimes would operate if the fracture was really bad. It generally worked out satisfactorily, but tellingly, many had learned not to operate when the fracture was really, really bad. The surgical results when the wrist was truly blown to bits often seemed to be worse than the results with closed treatment. The body can get it right - or at least more right than a surgeon can - once in a while...