highly doubting orthopedic treatment for finger injury

[Anonymous]

I'm not going to name the clinic yet but I am suspecting that the treatment we are receiving is not stellar, and financially disadvantageous to us. So, we saw someone for a pediatric finger injury that the x-rays showed to be a closed fracture. The doctor did not set it, even though the finger clearly looked off, top part was pointing slightly sideways, definitely misaligned. The doctor said we could come in one week and take another x-ray. Which we did. Guess what, there was no change, BUT now we owe money for the second cast because they could not see the bone through the first cast. Plus they took about 10 more xray images of the hand, thank you very much.

My question is: can a closed fracture miraculously realign itself in a cast in one week's time? I am not a doctor but my expectation would be zero change. So I am planning to contest this with the doctor and the billing department. He should have set the fracture the first time around, and this would have saved us from unnecessary xray exposure as well as hundreds of dollars in charges for new x-rays and the new cast.

[Anonymous]

As a person with many broken fingers and toes (I am a farmer), yes, it will likely “realign.” The calcification with develop with time, though a knob my remain after.

I’ve never had a broken bone “set” unless it is completely displaced and put back together with plates and screws. A couple of times I’ve had a bad toe break and the ortho recommended we wait and see…if it significantly displaces/moved out more, he would have had to pin it in place surgically, but that didn’t happen. A few years later all the extra calcification reabsorbed and it looks normal.

[Anonymous]

thank you for sharing your experience. I was wondering if an injury like this can realign in one week. I think the second set of xrays and new cast were unnecessary so soon after the initial casting appointment.

[Anonymous]

I've broken fingers through sports and never done anything with them other than tape the finger to other fingers. I've never even seen or heard of casting a finger, unless it was a very severe break? It all sounds a bit off.

But I'm also older, so maybe that was just the way they handled that "back in the day".

[Anonymous]

how would you tape a thumb to other fingers?

[Anonymous]

Anonymous wrote:thank you for sharing your experience. I was wondering if an injury like this can realign in one week. I think the second set of xrays and new cast were unnecessary so soon after the initial casting appointment.

Pp here…I did have that tor rechecked in a week-10 days to see if it needed pinned. The soon after appointment check isn’t to see if it realigned, but to see if it moved more and needs more intervention. You don’t want to wait a month and then try to pin a bone, it will have healed too much in the wrong way.

[Anonymous]

Bones heal differently than you think.

The second xray is to make sure it hasn't moved farther out of alignment.

[Anonymous]

Anonymous wrote:how would you tape a thumb to other fingers?

I assume you are asking the PP who mentioned taping the broken finger to the others. Here's a little tidbit to enlighten you: the thumb is not a finger.

Although in some languages, including the Icelandic and Russian, the thumb is referred to as “the big finger”, in other languages, including the English, it is considered as a special digit, a non-finger. There are anatomical and physiological reasons to separate the thumb from the fingers.


Short Answer: you don't.

[Anonymous]

Thank you for the enlightenment, really. I'm not going to start a new thread about non-finger injury, but since it's not a finger, does it heal differently?

I have broken an arm in childhood and it was definitely set by the doctor before it was put in a cast. So my doubts stem from my personal experience, which thankfully was limited. I just find it difficult to imagine how a misaligned bone would heal back straight. The top part of the bone has partially slid off the bottom part.

I do get the point about second xrays being for checking for any worsening alignment. Thank you for clarifying this for me. I guess there was a gap in communication with the doctor.

[Anonymous]

Why didn’t you ask the doctor at the time of the appointment so he/she could explain it and avoid all this unnecessary speculation on your part?

[Anonymous]

Good question. The clinic sent us instructions, which prohibited coming with more than one person. So my husband went in first and I stayed outside with a younger child. My husband did call me several times during the appointment to inform me about what was going on. I remember now that the doctor said he preferred not to set the finger because the fracture was close to a growth ring. He assured us it would heal by itself. And then the following xray was designed to show us that the finger was already healing. To the second appointment I came myself and there was not any discussion prior to taking xrays. The doctor did not even show up prior to xrays. Then he proceeded to recommend that he could set the finger as it hasn't improved, or something like this--he never said it was to rule out further misalignment. All in all, I am not pleased with communication at this place. It's impossible to get a hold of a specialist by phone too.

[Anonymous]

Not sure why you think the doc would show up prior to the x rays the second time. The purpose of the visit is to review x rays so it makes sense to take the X rays before.

None of your objections make any sense in terms of outcome. It sounds fine. And you have no way of knowing what was communicated because you weren’t even there for the first one.

The care sounds fine to me.

[Anonymous]

to pp, sounds like you work in that clinic

[Anonymous]

Anonymous wrote:Good question. The clinic sent us instructions, which prohibited coming with more than one person. So my husband went in first and I stayed outside with a younger child. My husband did call me several times during the appointment to inform me about what was going on. I remember now that the doctor said he preferred not to set the finger because the fracture was close to a growth ring. He assured us it would heal by itself. And then the following xray was designed to show us that the finger was already healing. To the second appointment I came myself and there was not any discussion prior to taking xrays. The doctor did not even show up prior to xrays. Then he proceeded to recommend that he could set the finger as it hasn't improved, or something like this--he never said it was to rule out further misalignment. All in all, I am not pleased with communication at this place. It's impossible to get a hold of a specialist by phone too.

Your expectations aren’t reasonable. Why would he come in prior to X-rays that were the reason you were coming back? He can’t give you a recommendation until he’s seen the X-rays so you want them to come in prior why? It sounds like they hoped the finger would heal on its own, but unfortunately your child’s didn’t and needed further treatment. It also sounds like you lack communication with your husband about the first appointment and are mostly angry about the cost, which is more an issue of crappy insurance.
Anyone who apparently disagrees sounds like “they work in that clinic” No one has agreed with you and DCUM loves to get fired up about doctors!

[Anonymous]

Anonymous wrote:Good question. The clinic sent us instructions, which prohibited coming with more than one person. So my husband went in first and I stayed outside with a younger child. My husband did call me several times during the appointment to inform me about what was going on. I remember now that the doctor said he preferred not to set the finger because the fracture was close to a growth ring. He assured us it would heal by itself. And then the following xray was designed to show us that the finger was already healing. To the second appointment I came myself and there was not any discussion prior to taking xrays. The doctor did not even show up prior to xrays. Then he proceeded to recommend that he could set the finger as it hasn't improved, or something like this--he never said it was to rule out further misalignment. All in all, I am not pleased with communication at this place. It's impossible to get a hold of a specialist by phone too.

There's no point in being seen by the ortho until after they've done an xray. They do the xray first, then the doc sees you after they've reviewed the xray. This is just how ortho works. It's also perfectly normal for ortho to take a very conservative approach and only intervene when necessary, particularly with kids. The entire point of the repeat xray is to see whether intervention is necessary. Everything you've described is perfectly normal for ortho.