EXPERIENCE and technical expertise matter in wrist fracture surgery
and are likely the most important factors in your outcome of wrist
A recent study of over 300 consecutive surgeries demonstrated that the majority of complications following surgery for distal radius fractures (such as tendon irritation, tendon rupture, hardware protrusion into the joint, hardware loosening, hardware removal, nerve injury, loss of reduction) were related to technical errors or incorrect hardware placement.
Normal and Abnormal Carpal Kinematics: The Importance of the Midcarpal Joint
CBS News Dr. Max Gomez Interviews Dr. Wolfe on Wrist Surgery
Dr. Wolfe and Dr. Crisco's Hand and Wrist Motion Analysis
Dr. Wolfe is an international authority on the treatment of wrist fractures. Patients with acute wrist injuries and chronic problems related to untreated or undertreated wrist fractures constitute a large portion of his practice. He treats all types of fractures of the wrist and hand including; distal radius fractures, scaphoid fractures, scaphoid non-unions and wrist dislocations.
Distal Radius Fractures
Making up roughly 80% of the wrist joint, the distal radius is a common bone to break in a sports-related accident or fall. Treatment options include casting, surgery or a combination of both. Dr. Wolfe bases his treatment recommendations on a variety of injury- and patient-related factors and discusses all options and outcomes with each patient. He customizes a treatment plan for individual fracture types, patient needs and activity levels. His goal is to achieve prompt and secure fixation of the fracture fragments - whether by casting or surgery – to enable the injured patient to begin rehabilitation soon thereafter. Often patients may begin to use their injured hand again within days. Incorrect initial treatment may ultimately require difficult secondary reconstruction and/or bone graft, and may not always reverse the loss of motion and arthritic changes that may have already begun.
A scaphoid fracture often occurs when one falls on an outstretched hand. Its symptoms can be vague and difficult to detect, but missed or delayed diagnosis can result in long term impairment and painful consequences. Due to the scaphoid bone’s complex shape and unstable blood flow, untreated broken fragments may not heal, and the subsequent arthritis can be disabling. Dr. Wolfe thoroughly investigates every wrist injury with highly specific xrays and advanced imaging to ensure accurate diagnosis and treatment.
Scaphoid fractures occur most frequently in young athletes and may often be dismissed as a sprain. Unless identified as a subtle crack on initial xrays, the injury can go undiagnosed for months or years. This often silent injury can unravel the complex balance of the eight bones of the wrist, setting in motion a downward spiral of stiffness, swelling and relentless arthritis. Early symptoms of pain, bruising and swelling may temporarily resolve only to return with widespread pain preventing full motion or use of the wrist. Dr. Wolfe treats many patients with undiagnosed scaphoid injuries which are in various stages of arthritis and now require surgery.
With a keen understanding of the past failures of wrist replacement, Dr. Wolfe and his longtime colleague, Trey Crisco, PhD., secured NIH funding to unravel the mysteries of wrist motion. They importantly discovered that functional activities such as throwing and hammering are enabled by wrist anatomy that was shared by our primate ancestors. This realization enabled their team to develop and patent the first “mid-carpal” wrist replacement. This unique, new wrist replacement is designed to utilize the joint surfaces responsible for complex multi-planar motion – a distinct departure from the constrained prostheses of the past. The new Kinematix™ wrist more closely mimics normal wrist motion. Improved motion, more consistent with the actual complex motion of the human wrist, is hoped to lead to increased durability of the implant, and allow younger, active patients who are disabled by wrist arthritis to engage in sports again. The first patient to receive such a wrist now enjoys golf several days a week nearly three years after his surgery in London. Wolfe and Crisco anticipate FDA approval for use of their unique, new Kinematix™ wrist in 2014.
In collaboration with his colleague, friend, and long-time co-researcher Trey Crisco, PhD.,, Dr. Wolfe has successfully garnered over four million dollars in competitive research grant funding to study the mysteries of wrist motion, injury and mechanics. In the 1990s, with NIH sponsorship, their published work provided the software foundation for Four Dimensional (4D) wrist motion analysis. This is the ability to track and measure multiple small, intricately-shaped wrist bones as they roll and glide during hand and wrist function. Through nearly twenty five years of collaborative work, Wolfe and Crisco have published key insights to help clinicians better understand the consequences of wrist fracture, ligament injury and instability. Wolfe teaches his innovative insights into ligament repair and reconstruction to hand surgeons around the world.
With a fundamental understanding of wrist injury and mobility, Dr. Wolfe provides his patients with important prognostic information as well as customized choices for the most complex wrist injuries.