Hi Graham. I'm really sorry to hear about your hand fracture and that you are in a foreign country. You must feel helpless. I am an Orthopedic Surgeon here in the United States. I would be happy to help.

Please keep in mind that what I offer is only for informational and educational purposes and should not be deemed as treatment or medical care.

Do you have a copy of the xray of the fracture? If so, you can post it as another question and I would be willing to take a look at it.

A Bennett's fracture is an intra-articular fracture of the base of the first metacarpal bone of the hand. It's a fracture of the base of the thumb joint that connects the thumb to the wrist. This joint is also known as the carpometacarpal joint (CMC joint).

Because it is intra-articular it needs to be fixed in surgery with pins that hold the fracture reduced in place. Due to the attachment of certain hand muscles and key ligaments, this fracture will not heal on its own unless things are pushed into place and held with pins or with a screw.

If the fracture is very tiny, an avulsion type, then you could be treated with a special cast called a thumb spica cast.

Long term complications of not having this heal in the correct position is chronic base of thumb pain and arthritis of the CMC joint.

As for pain medicine, tylenol is not a narcotic and that is what most Orthopedists give patients with a fracture. Usually we do an upper extremity nerve block or what is called a Bier block with local anaesthesia at the time of surgery. This is followed by pain medications. The patient is placed in a cast for 6 to 8 weeks to allow it to heal with several cast changes.

I think if you are concerned with your care there you should consider coming home to have it fixed. I don't know what the xray looks like but that if it requires surgery that is what I would recommend for any family member or friend.

I know nothing about the healthcare delivery system there but I do know that in the US it is the most rigorous in terms of quality control and training of its physicians.

Good luck to you. Feel free to message me or follow up. I usually check questions once or twice a day. Thanks.

Hi there. Sorry for the delay. I was on a plane all day yesterday and was unable to get online at night. I am at a conference and can only get online in the evening, so please bear with me if I can't answer your questions right away.

I'm not sure why they are not using narcotics there in Finland. Have you asked about getting some? We would give you something with hydrocodone in it such as vicodin, norco, percocet, or oxycodone.

It sounds from your original description that they haven't seen this fracture before so maybe they don't know how painful it is.

A nerve bock and the Bier block are different blocks. The nerve block is an injection into the nerve plexus to give you post-operative relief even with general anaesthesia.

The Bier block is a local anaesthetic that is given into the veins but a tourniquet is used in the upper arm to trap the anesthetic there during the surgery. At the end of surgery the tourniquet is released so there the anesthetic the circulates out of the arm. Usually you would either be also under general anesthesia or moderate to deep sedation.

I would do a general anesthetic with a nerve block. However a nerve block must by done by an anesthesiologist who is comfortable with it and a lot are not unless they do it all the time. I would prescribe a narcotic post-operatively and discharge you same day of surgery.

If you demanded to stay in the hospital or if they do that in Finland you could ask for a PCA (patient controlled analgesia) pump with morphine in it.

You really should let them know you are in pain and need something more than T3. It is inhumane to leave a patient in pain.

Good luck to you. You know where to find me. Thanks.