Doc: ‘Fracture disease’ needs better explanation
Dear Dr. Roach: I am a 63-year-old female who broke her wrist in June. There were three fractures involving both the radius and the ulna. Surgery was required, with two metal plates installed. After nearly six months of occupational and physical therapy, my wrist and hand still are extremely stiff and have limited range of motion.
I was not ready to accept that nothing further could be done to restore my hand. I went to another hand specialist and was told that I have fracture disease, and a bad case of it. He gave me a cortisone injection into the wrist. That just made the pain in the area worse. It was supposed to help soften up things in the region, but I haven’t noticed that yet.
I’d like more information on what “fracture disease’’ is. Can it be cured, and what treatments would be recommended? Also, I’m considering removal of the two plates in a future surgery. I hope you can provide more insight on fracture disease.
Dear C.B.: I can sometimes figure out what medical professionals say from secondhand information, but this is one time I am at a loss. There are many conditions that increase risk of fracture. The first I would think of in a 63-year-old woman is osteoporosis, which is a loss of bone minerals throughout the body. This occurs in men and women, but women are at far higher risk due to accelerated loss of bone strength after menopause and because women tend to have lower bone strength than men do. Osteoporosis usually IS diagnosed by a bone density scan (but could possibly be made by surgical specimen), and is most commonly treated with diet, exercise and medication by a generalist, rheumatologist or endocrinologist.
I’m not convinced that that is what is going on. Osteoporosis wouldn’t explain the postoperative problems you are having, so there is some other process, possibly inflammatory, involved. I would suggest another visit with the surgeon who operated on you or the hand specialist to get a more precise diagnosis, and referral, if indicated.
Dear Dr. Roach: I wanted to give some feedback to your recent column on lymphedema.
I personally understand the concerns of getting lymphedema. After a mastectomy or lumpectomy, the concern about lymphedema is high. As a patient, you are warned about the risks of any injuries to that arm for the rest of your life. You also are told not to have any needle pricks or blood pressure taken on the impacted side. I, too, was worried about what might happen in an emergency situation if I could not say, “No pricks or BP on that arm” and decided to have not only a medical ID bracelet made with those instructions, but also medical tags (with that same statement) to put on my keys and my lanyard with my work badge. Having a medical ID card in your wallet next to your driver’s license or ID card adds another level of notification to anyone helping in an emergency.
Dear D.W.: I thank D.W. and others for writing. Medical ID jewelry and cards are good ways of getting critical information to emergency medical personnel, and also can give you some peace of mind.
Email questions to ToYourGoodHealth@med.cornell.edu.