Group of Cape Girardeau doctors using new method to heal fractured wrists that reduces healing time.

For years patients who suffered a broken wrist were automatically fitted for a cast, waiting six weeks or more for bones to heal. A new procedure endorsed by a local orthopedic surgeon is changing that.

This little metal device is implanted exactly where most breaks occur: the forearm bone on the thumb side of the arm (Diane L. Wilson)

Dr. Brian Schaefer of Orthopaedic Associates in Cape Girardeau discovered the Micronail Fixation system about two years ago when it first came on the medical market. The device is little more than a 1-to-2.5-inch metal bar with five screws that can be implanted in the wrist bone.

By itself, it's not much to look at, but to Schaefer it was revolutionary.

"Basically this is the first time anyone has done anything like this. The traditional way to do it was either an external fixator or making a big incision and putting in a plate and screws ... What makes this so good is the minimal direction and all the fixation is internal, so they can start moving right away," Schaefer said.

Schaefer and his partners are the only doctors in town currently doing the procedure.

The little metal device is designed to be implanted where most breaks occur: the forearm bone on the thumb side of the arm known as the distal radius.

After surgery, Schaefer asks his patients to keep their hands braced for up to two weeks but says it is precautionary. The wrist can undergo a full range of motion as soon as the 45 minute surgery is complete.

"It's so strong; that's what makes it work so well. Immediately after I put it in there, I actually put their wrist through a range of motion and nothing moves. Some guys will just let them start moving immediately, but I usually keep them in a splint for about two weeks. But it's a removable splint," Schaefer said.

Schaefer has done the procedure about 30 times and says he now uses it whenever possible. Some more complex breaks still require six weeks in a cast or, alternatively, surgery to implant plates and screws, he said. Currently he uses Micronail on about 50 percent of patients with fractured wrists.

Schaefer, though, tries to avoid these options. He said casts often result in "settling" where set bones move during healing. Implanting plates and screws is typically a longer and more invasive surgery than the one required for Micronail.

This X-ray showed the device, a little more than a one to 2.5-inch metal bar with five screws implanted in the wristbone of a patient. (Diane L. Wilson)

Many fractures

Both plate and cast procedures can result in stiffness and less range of motion, Schaefer said.

Nationwide, about 300,000 people a year suffer wrist fractures. Older people are particularly susceptible to the breaks which often occur during falls when people try to brace themselves.

One in six women over age 55 will suffer a wrist fracture during their lives according to clinical research.

Snapped wrist

Anna Wagganer says she can testify to the efficacy of the new procedure. In January, the Cape Girardeau woman who gives her age as "over 60" slipped on a grassy embankment outside her home.

Trying to break her fall, she snapped a bone in her left wrist. After a referral from her family doctor, she decided to try the Micronail.

At first she was hesitant.

"When they said they were going to put screws in my wrist I said, 'no I don't want that.' I thought, 'Why can't they just put me in the cast?' " she said.

But Wagganer thought back to when she broke her right wrist in 2000 during a similar fall. After that break, she wore a cast for six weeks and has endured stiffness in the wrist since.

Wagganer said the healing has gone smoothly.

"If you had to break a bone, this was the best experience possible in my opinion," she said.

"This second break was worse, but it healed quicker. Very quickly, I could use my fingers, type a little bit, and I could hold little things like a coffee cup."

Wagganer said she hopes never to break another wrist, but will recommend Micronail to anyone who asks.

Some, though, are still skeptical about Micronail.

Dr. Pedro Beredjiklian, a hand surgeon at the University of Pennsylvania, said he operates on between 70 to 100 broken wrists per year. He said Micronail is good for clean breaks, but he doesn't see many clean breaks.

"It's one option for a very specific indication. It's not a panacea," he said.

More and more, Beredjiklian said he is seeing older people with brittle bones who lead active lives. When these patients break wrists, it is often fragmented.

Little data

"I would say it's not really applicable to treat many of the fractures we see," he said, adding that since the procedure is so new there is little data about long-term side effects.

"We don't know what happens with this one year or two years out," he said.

Schaefer, though, remains a proponent.

"Let me put it this way, if I ever broke my wrist in that place, it's what I would want," he said.

tgreaney@semissourian.com

335-6611, extension 245