Hand Surgeons Dr. Hildahl and Dr. Parisi Discuss Hand Treatment Advances
Learn how treatment advances have significantly improved care for two common hand conditions: wrist fractures and Dupuytren’s contracture.
Our hands literally enable us to grab life’s opportunities. When they are injured, the impact on our lives is immediate. Upper extremity surgeons Dr. Blake Hildahl and Dr. Debra Parisi use their expertise to help patients quickly and comfortably get back to reaching for the best in life after a hand injury. They reflect on medical treatment advances that have dramatically improved care for two hand conditions they treat regularly: wrist fractures and Dupuytren’s contracture.
Treatment advances for wrist fractures
“One of the most common injuries we see are distal radius fractures,” says Dr. Hildahl. “These are the injuries that occur when someone falls on an outstretched hand and fractures bones in the wrist. When we lose our footing, we instinctively reach out to break our fall—putting our wrists at risk. Given our state’s infamous winters and especially the icy spring weather this year, it’s easy to understand why we treat so many distal radius fractures.”
The historical treatment for wrist fractures was external fixation
Dr. Parisi explains that the medical approach to distal radius fracture treatment has changed significantly—and in ways that dramatically improve the patient experience. “When I was doing my training,” she remembers, “the treatment approach for wrist fractures was to do a reduction and then put patients in an external fixator. Using an external fixator means patients have pins extending from the bone through the flesh and skin. An external bar connected the pins and held the bone in place while it healed. External fixators look intimidating and make movement awkward. And because this is an external device that connects down to the bone, there is an increased risk of infection.”
Dorsal spanning plates offer patients a more comfortable treatment
Fast forward to 2018. “We still use an external fixation in cases where there is a lot of soft tissue loss,” concedes Dr. Hildahl. “But thanks to treatment advances, external pins and bars aren’t the only approach for fracture treatment. Today we have a new option: internal fixation using dorsal spanning plates. These plates are placed under the skin to cross the wrist joint and temporarily hold the wrist at full length during regrowth and healing. After three months, when the bone and tissue have healed, the plate is removed through a small incision.”
This internal fixation approach improves the patient’s experience throughout treatment. “There’s a lower infection risk,” notes Dr. Parisi. “And patients are able to move a lot more quickly and get back to their function much sooner than they could in the past.”
“It’s also much easier psychologically for the patient after surgery,” adds Dr. Hildahl. “No one likes the Frankenstein look of external pins and bars.”
Treatment advances for Dupuytren’s contracture
“The other area where we’ve seen a real evolution in treatment is in the way we treat Dupuytren’s contracture,” explains Dr. Parisi. “Minnesota was settled by Norwegians and Swedes, and Dupuytren’s disease has a genetic component that’s been traced to Northern Europe. It commonly runs in Norwegian and Swedish families, so we see a lot of it in Minnesota.”
Dupuytren’s disease causes the tissue in the hand to contract. The little finger and ring finger are most susceptible to the condition, but all fingers can be affected. The first symptom of Dupuytren’s contracture is the formation of one or more small painful bumps under the skin in the palm. Gradually, these bumps thicken and contract. As they toughen, the thickened tissue begins to pull one or more fingers toward the palm. Over time, the fingers become more curled and it becomes harder to straighten them.
The historical treatment for Dupuytren’s was surgery
“We are hand surgeons,” states Dr. Hildahl. “But that doesn’t mean that surgery is the first option we consider. We firmly believe that no operation should be carried out unless absolutely necessary. There was a time when the only way to treat Dupuytren’s was with extensive surgery to remove the contracted tissue. But I’m happy to tell you that today, there are other excellent and less invasive treatment options for this condition.”
Advanced injections offer a less invasive treatment option
“There is still a place for surgery to treat Dupuytren’s,” says Dr. Parisi. “But treatment advances have given us a wider range of care options to offer our patients. Today, before we even consider surgery, we use injections developed to help break down the contracted tissue. In some cases, injection treatment is so successful that we can avoid surgery all together.”
Summit Orthopedics offers upper extremity expertise and personalized care
Summit Orthopedics is home to fellowship-trained hand surgeons who have received the highest levels of training and exclusively provide care for conditions of the hand, wrist, and elbow. These orthopedic hand surgeons practice in Vadnais Heights, Woodbury, Eagan, Apple Valley, Blaine, Hastings, and St. Paul, Minnesota.
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