Blood Thinning Medications

The risk of bleeding in hand surgery procedures is fairly low. We tend to stop certain blood thinning medications like Disprin (aspirin), Plavix (clopidrogrel) or Warfarin before elective procedures. We weigh up the benefit of the procedure against the risks of stopping certain medications. Some Warfarin patients might need to be pre-admitted to change to a blood-thinning drug (Heparin) that can be adjusted more readily. Disprin is an anti-platelet drug and should be stopped a week before the procedure. Please discuss this in your consultation with me to formulate a plan.

Fasting Rules

The most important thing to note before an operation, is to be fasted for six hours by the time of the operation. This is to ensure that there is no stomach content that can be aspirated in the lungs at the time of the operation. The risk of aspiration of the stomach contents, (choking on and inhaling stomach contents), when normal reflexes are suppressed by a general anaesthetic, is drastically reduced when the stomach is considered empty after six hours. You will be advised to be fasted (fluids and solids) from the night before if your operation is performed in the morning. Afternoon cases can usually have an early breakfast or coffee/rusks depending on the time of the scheduled case. Please enquire if you are uncertain.

Chronic Medications

Please continue your normal chronic medications (like anti-hypertensives) the day of the operation. You can take it with a small sip of water.

How are wrist fractures treated?

Most wrist fractures can be treated with a cast or splint to immobilise the wrist and thereby facilitate bone healing. In displaced or unstable wrist fractures, the best treatment is wrist surgery to reduce the bone fragments in the correct position and to then stabilise the fracture by fitting a plate, which keeps the bone fragments in a reduced position. This is called an open reduction and internal fixation (ORIF). A stable fixation facilitates early mobilisation and ensures a good outcome.

Generally, treatment goals for wrist fractures are initially to reduce swelling and to get the fingers moving as soon as possible. Dr van der Spuy will immobilise your wrist for approximately 4-6 weeks with conservative management in a cast. With a surgical fracture fixation, this can be a bit earlier between 2-4 weeks, once the fracture is stable enough. Most patients will experience stiffness and some discomfort and pain for up to six months post-surgery, depending on the severity and complexity of the wrist fracture.

Other Considerations

There are a few preparations that you have to consider before the surgery. Any shaving of hair required will be done in theatre. Please remove all nail polish and make sure that nails are clean and cut. If you live alone, consider the fact that it will be a challenge for you to fulfil your normal daily activities from preparing food to basic hygiene activities. Please make sure you prepare for this.

Driving is likely to be difficult in most cases post-operatively, especially if the limb is immobilised in a cast. You may have to speak to your insurer. Please make arrangements for someone to collect you from the hospital after the procedure.

Finally, most patients are booked off from work for a period of recovery. This will be discussed between you and Dr van der Spuy and will depend on the type of work that you do and the kind of operation that was performed. Please advise the practice if you require specific letters for your employer before the operation.

Finally, make sure that you have a good book to read after the operation. You don’t always get a pass for leisure time like this!