Wrist fractures
A broken wrist is also known as a wrist fracture. A wrist fracture may occur as a result of falling onto the hand. More serious wrist fractures can occur following severe trauma such as car accidents. People with weak bones and people who play sports are usually more prone to wrist fractures. Wrist fractures often require the use of casts, braces, or other devices. Sometimes, surgery is needed to help heal a wrist fracture.
Surgical options for wrist fractures
If surgery is necessary for a wrist fracture, one of two primary surgical procedures will probably occur. These procedures include external fixation and internal fixation methods.
External fixation devices use pins to secure bones in place. There are two main methods to keep pins in place:
- Bridging external fixation – when a frame extends across the wrist joint, which keeps the wrist in a fixed position.
- Non-bridging external fixation – when a frame does not bridge the wrist joint, which allows for movement earlier in recovery.
For internal fixation surgery, plates, screws or pins are implanted to hold the bone fragments in place [1]. Bone growth stimulators can be used either in place of or in addition to surgery. This is especially the case if a fracture becomes nonunion (or the fracture halts in the healing process).
Bone growth stimulators and wrist fractures
Bone growth stimulators can be used to promote healing in a nonunion fracture, including fractures of the wrist. Several different options are available, including Combined Magnetic Field (CMF), Pulsed Electromagnetic Field (PEMF), and Low Intensity Pulsed Ultrasound (LIPUS) devices. For instance, the PhysioStim PEMF device from Orthofix is approved by the Federal Drug Administration (FDA) for the treatment of nonunion fractures of the wrist [2]. A clinical study of this device demonstrated success rates of 80% when it was used for more than 3 hours per day [3]. In a study of a LIPUS unit from Exogen, twenty-six hand and wrist nonunion fractures were treated with LIPUS alone or as a surgical follow-up, and the overall success rate was 62% [4]. In only 20 minutes per day, Exogen’s bone stimulation device accelerates healing throughout the fracture healing process [5].
Insurance coverage and criteria
Whether or not a bone growth stimulation device is covered by insurance depends on your provider. Further, the type of bone growth stimulator will also affect criteria for insurance. For example, if electrical or electromagnetic bone growth stimulation is sought and the insurance provider is United Healthcare, the fracture must have 90 days of no healing. You must also provide official medical notes documenting all of the following: 1) current physician prescription; 2) documentation explaining the reason a bone growth stimulator is needed; 3) any risk factors that apply (including obesity and smoking). Also needed are medical office notes documenting: 1) date, site and type of fracture; 2) diagnostic imaging reports; 3) treatment of the fracture, including treatment already completed and treatment planned [6]. You can find out more about general insurance criteria for coverage for many providers here.
References
[1] Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS, Watters III WC, Goldberg MJ, Keith M, Turkelson CM. Treatment of distal radius fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2010;18(3):180-9.
[2] Product Features & Benefits. Accessed 8/29/2020. http://www.bonegrowththerapy.com/therapies/physiostim-arm-wrist-hand
[3] Garland DE, Moses B, Salyer W. Long-term follow-up of fracture nonunions treated with PEMFs. Contemporary orthopaedics. 1991;22(3):295-302.
[4] Elvey MH, Miller R, Khor KS, Protopapa E, Horwitz MD, Hunter AR. The use of low-intensity pulsed ultrasound in hand and wrist nonunions. Journal of Plastic Surgery and Hand Surgery. 2020;54(2):101-6.
[5] Heckman JD. Ryaby JPm McCabe J et al. Accelerative of tibial fracture-healing by non-invasive low-intensity pulsed ultrasound. J Bone Joint Surf Am. 1994;76(1):26-34.
[6] Electrical and Ultrasound Bone Growth Stimulators. 2020. Accessed 8/29/2020. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/electrical-ultrasound-bone-growth-stimulators.pdf