Hello Dr., I have a Bennett Fracture on my my right thumb from a stupid mishit at my local gyms boxing bag. I am an American overseas in Finland so Ineed your help as there is some language barrier. First Ihave read aboutthe long term effects of this. The doctor tried VERY VERY painfully to pull the bones back together but hat did not work. So I need surgery. They will callme anytime with what day this week to come. I will be put to sleep so obviously ananesthiologist willbe present. And then maybe a stay overnight. I was crying in pain for the hour after he tried to realign me (left alone ina room by myself). This is a public sysem doctor here and the nurse herself said that she had never seen a fracture like this in her 30 years. Should I really look for a VERY specialized hand surgeon to avoid future problems with arthritis etc... Also as we speak I have been given 1 Tylenol #3 4 times a day. I am a Pharmacist originally from Philadelphia and this is a joke whatthey have given me. I am in so much pain right now but in this country this is the strongest they will give from a pharmacy. What would be done in the states. Because honestly if I am put trough this much pain here, I would potentially fly back for some honest relief. I cannot take care of my 3 and 4 year old children on T3s. What do you think?? How will the pain be after surgery?? For how long?? etc etc. Thank you, XXXXX XXXXX
Ignorant Finnish doctors thatbtellme pain relief comes from the cast...
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.
Thank you for getting back to me. I have a few additional questions. First I just wane
wanted to let you know that Fnland is top notch with doctors. Many, even American Sports starts come here come here for their expertise. So that is not my concern. In addition to everthing that you have answered, I still have a few more. First off you said that "As for pain medicine, tylenol is not a narcotic and that is what most Orthopedists give patients with a fracture. To me even thoug I have not practiced ina retail setiing in10 years, everytime a patient came in with a cast, it was usually for Oxycodone. So in this time of extreme pain, why is it your opinion that doctors dont use Narcotics. For goodness sakes, I cant inmagine a time I would need them more...
Then you talk about this Nerve Bier Block. I will be put out under local anesthesia and that is all they telll me. They say my stay will depend on how much pain I am in. Maybe that is because the strongest thing Pharmacies have is Ultram lol hahahahahahah. I had so many patients in my CVS store in Philadelphia that didnt evenwant to pay there medicare 1.50 for Ultram, being so weak...
So why would they put me to slep with ananesthisiologist rather than this nerve block??? What you prescribe after this type of surgery?? Of course some kind of opiod thatthey really dont use here correct??? That is what I have always seen at CVS. I am in tremendous pain now given Tylonols #3s 30mg-50omgs. I cant take any more pain this with T3s. So will I be in much pain after surgery for a long time????
Thank you and sorry for the
8 million questions throughout this. I hope that you can answer them all. Sincerely, Graham
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.