Is Someone Pulling a Fast One?

[Formaleins]

Not sure but something seems a bit strange with this. I smashed my wrist yesterday and went to the local government hospital. Had an X-ray which confirmed it was well and truly broken, both of the large bones from my arm are smashed next to the wrist. They strapped it up and put on what they described as a "soft cast" gave me meds and I paid the bill, all told it was about 1000 Baht.

It was late yesterday evening so the doctor in the emergency and accident was a general doctor and I believe she contacted an orthopedic doctor who looked at the X-rays. They then asked if I had insurance as they now wanted to put in various metal work, screws bars pins etc. (I don't have that insurance cover anyway)

They then told me that I should pay 30K Baht to have it fixed properly as if I didn't there would be no guarantee that my wrist/hand would work properly again and it might end up twisted.

It seemed a bit strange to offer this service (told to return in 3 days for the op) after patching me up. I was wondering if the doctor could be doing a bit of moonlighting or similar, and to be honest, 30K seemed pretty expensive for a government hospital.

 

Is this the going rate to fix broken bones? it is not my writing hand anyway so it really doesn't need to be perfect, I am no spring chicken and have never broken a bone before so not sure really if it is even worth bothering with. I sort of expected if they set the bone with a cast that would be the end of it and all the metalwork will just be more of a PITA, so I don't think I will bother.

If a government hospital is charging 30K, how much would it be in some private hospital like the Ram? it must be close to 100K, seems awfully expensive to me or maybe I am just out of touch.

[richard_smith237]

You used the phrase 'smashed' wrist, which implies multiple irregular fractures. 

 

As you went to a government hospital they are used to people not being able to afford the 'full treatment' and in this case many locals would accept emergency treatment (cast) and pain medication. 

 

The cost of further treatment may include an operation; surgeon, anaesthetist, pinning etc.. 

If so, 30,000 baht seems very cheap. 

 

On the face of it, it would appear that you are receiving some pretty decent and fair attention. 

 

[Formaleins]

2 minutes ago, richard_smith237 said:

You used the phrase 'smashed' wrist, which implies multiple irregular fractures. 

 

As you went to a government hospital they are used to people not being able to afford the 'full treatment' and in this case many locals would accept emergency treatment (cast) and pain medication. 

 

The cost of further treatment may include an operation; surgeon, anaesthetist, pinning etc.. 

If so, 30,000 baht seems very cheap. 

 

On the face of it, it would appear that you are receiving some pretty decent and fair attention. 

 

OK, thanks for that, just seemed a bit OTT for a broken wrist. Would they put you to sleep for this sort of thing? I expected a jab in the arm to be honest.

[grollies]

OP, sounds about right at B30k.

 

'Friend' of ours, his son came off his scooter, broke his wrist. Govt hospital exactly the same treatment and comments.

 

We ended up stumping up B30k for the op, pins, screws, etc. He was Thai farang's kid, not registered in our district so had to be paid for.

 

I was interested in the similarities between your situation and his.

 

Hope you get fixed anyway.

[Khaeng Mak]

My girl broke her wrist last year when T-bone on her motorbike by an unlicensed woman driving her husbands car while looking at her phone.

 

Total cost for temporary cast, bone realignment and then fiberglass cast was 1200 baht including drugs.

 

Government hospital.

[Formaleins]

Does anyone know if it is possible to get it "fixed" properly (pins/screws etc.) at a later date - say for instance when the cast comes off and it turns out to be a problem using my hand? could they do the full repair then or is it done with once it has healed?

[lopburi3]

I also believe price to be reasonable and definitely not a 'fast one'.  Appears you did not have a clean break so cast alone not the preferred treatment.  With pins and such in private hospital expect would cost several hundred thousand baht in today's world.  I spent 220k for liver biopsy/RFA (which is pin size entry and less than an hour).  And they did put to sleep and 3 nights in hospital.  CT scan costs about 20k and MRI about the same.  Hospital treatment is not cheap - and for your operation expect they will have to use imported materials that are very costly (even for government hospital).  

[tlandtday]

No one here is in a position to give you proper advice without seeing the xrays and having some knowledge of how to read them. I would get the x rays from the hospital (or get new ones) and go to another doctor and ask him to look at them and let you know if it will heal properly.  Tell them you are flying back to your home country soon so there is no interest in them getting payment from it.

[lopburi3]

Just now, Formaleins said:

Does anyone know if it is possible to get it "fixed" properly (pins/screws etc.) at a later date - say for instance when the cast comes off and it turns out to be a problem using my hand? could they do the full repair then or is it done with once it has healed?

Not a doctor but believe that would be highly unlikely to be a good option.  Expect would be much more complex and require damage to healing that had already occured.  

[Formaleins]

2 minutes ago, lopburi3 said:

_{I also believe price to be reasonable and definitely not a 'fast one'.  Appears you did not have a clean break so cast alone not the preferred treatment.  With pins and such in private hospital expect would cost several hundred thousand baht in today's world.  I spent 220k for liver biopsy/RFA (which is pin size entry and less than an hour).  And they did put to sleep and 3 nights in hospital.  CT scan costs about 20k and MRI about the same.  Hospital treatment is not cheap - and for your operation expect they will have to use imported materials that are very costly (even for government hospital).}  

Jesus, no wonder the cost of insurance is so expensive, I really did not expect that it was such a big procedure.

[BritManToo]

15 minutes ago, Formaleins said:

Does anyone know if it is possible to get it "fixed" properly (pins/screws etc.) at a later date - say for instance when the cast comes off and it turns out to be a problem using my hand? could they do the full repair then or is it done with once it has healed?

If it were me, I would just go with the 1000bht work done and a cast.

 

There are pros and cons.

Metalwork generally causes more pain, but you get movement back quicker.

The standard plaster cast will cause less pain, but immobility for a longer period, then a longer recuperation without the cast as you will have lost muscle tone. Also the metalwork tends to work it's way out at a later date, causing even more operations, pain and expense. I've had various breaks in the past, and always recovered fully with just plaster.

 

Look at your after plaster x-ray, if everything has lined up you'll probably be OK.

[lopburi3]

2 minutes ago, BritManToo said:

I've had various breaks in the past, and always recovered fully with just plaster.

But at what age?  OP mentions not being a spring chicken and we tend to not heal as well on that side of the hill.  

[BritManToo]

Just now, lopburi3 said:

But at what age?  OP mentions not being a spring chicken and we tend to not heal as well on that side of the hill.  

My son was 13 when he had a broken wrist in the UK (fell over on the field at school), they put metalwork (John Radcliffe Oxford) in, it didn't heal straight, and the pins and screws have been working their way out for the past 20 years causing endless problems. There are no guarantees with any treatment, and a lot depends on the training and competence of the doctor treating you. it's all a dice roll.

[Formaleins]

4 minutes ago, BritManToo said:

If it were me, I would just go with the 1000bht work done and a cast.

 

There are pros and cons.

Metalwork generally causes more pain, but you get movement back quicker.

The standard plaster cast will cause less pain, but immobility for a longer period, then a longer recuperation without the cast as you will have lost muscle tone. Also the metalwork tends to work it's way out at a later date, causing even more operations, pain and expense. I've had various breaks in the past, and always recovered fully with just plaster.

 

Look at your after plaster x-ray, if everything has lined up you'll probably be OK.

I tend to agree. I have had a problem for about two years with that hand anyway, I have pain from one of the tendons, I suffer from cramping and numbness that can make some things difficult. I rally just want to be able to use my hand within reason, probably the main thing is operating the throttle on my motorbike. I already often get the cramp and finger locking while riding at times and am really worried that going in there and putting bits of metal inside will make it even worse. If it ended up worse I think I would no longer be able to ride the bike, so I would rather leave alone and take a chance.

[Formaleins]

6 minutes ago, lopburi3 said:

But at what age?  OP mentions not being a spring chicken and we tend to not heal as well on that side of the hill.  

mid fifties.

[Sheryl]

Repairing a fracture with pins etc will indeed cost at least 30k in a government hospital and about 10 - 15k of that will be the hardware. A simple general surgery not requiring any sort ofmetal implant or prosthesis in a government hospital genetally runs 15-20k.

 

These are very cheap prices.

 

At a private hospital this will run well over 100k. Maybe even over 150k.

 

You would be extremely ill advised to not have the fracture treated properly. You may have a lifelong deformity as a result and trying to correct it after the bone has healed, if it is possible at all , will cost far more.

 

Standard first aid for a fracture is to immobilze the limb and clean the wound. That may have been what was done initially pending ortho consult. It certainly doesn't sound like they reduced the fracture. But if you have doubts as to whether the surgery is necessary, get another opinion. (Bring the Xray with you).

 

Fractures are not all the same. Some are just hairline cracks with the bone still in alignment. Some result in the bone being out of alignment but with a single clean break. Some result in fragments. Etc etc. It also matters where exactly the fracture occurs.

 

The surgery being proposed can be done under either general or regional anesthesia (nerve block).

 

You should also do something about getting health insurance. A really major accident (head trauma etc) or catastrophic illness can reach 1 million baht in a hovernment hodpital and 3-5 million in a private hospital.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[Formaleins]

3 minutes ago, BritManToo said:

My son was 13 when he had a broken wrist in the UK (fell over on the field at school), they put metalwork (John Radcliffe Oxford) in, it didn't heal straight, and the pins and screws have been working their way out for the past 20 years causing endless problems. There are no guarantees with any treatment, and a lot depends on the training and competence of the doctor treating you. it's all a dice roll.

Thanks, I think best left alone!

[richard_smith237]

Another point to add... 

 

The Doctors are the experts... and while there is naturally  suspicion that a private hospital may exaggerate treatment and increasing costs / profits, a public hospital hardly makes a profit.

 

I would be inclined to believe the medical experts.

 

There has been some good advice so far on this forum, especially regarding Brit mans comments about pins and the potential for further discomfort etc...  this should also be discussed with your doctors so you can make an informed choice. 

 

 

[Formaleins]

2 minutes ago, richard_smith237 said:

Another point to add... 

 

The Doctors are the experts... and while there is naturally  suspicion that a private hospital may exaggerate treatment and increasing costs / profits, a public hospital hardly makes a profit.

 

I would be inclined to believe the medical experts.

 

There has been some good advice so far on this forum, especially regarding Brit mans comments about pins and the potential for further discomfort etc...  this should also be discussed with your doctors so you can make an informed choice. 

 

 

Agreed 100%! I often find myself pleasantly surprised with the quality and helpfulness of some of the advice from many of the posters on here. Some very good points both ways which makes things a bit more difficult for choice, food for thought, I will think this over, but I am probably going to give the metal work a wide berth. Thanks for all of the replies, very interesting.

[Kwasaki]

14 minutes ago, Formaleins said:

mid fifties.

I was 70 fractured wrist not broken a few future hospital visits and meds all fixed about a 1000 + a bit. 

[BritManToo]

10 minutes ago, Formaleins said:

Thanks for all of the replies, very interesting.

Has most of the pain gone yet?

My broken wrist (many years back) hurt like hell the first night, then a dull ache for another three-four days, then it was just awkward in the cast for six weeks with no pain at all.

[uhuh]

53 minutes ago, Formaleins said:

Does anyone know if it is possible to get it "fixed" properly (pins/screws etc.) at a later date - say for instance when the cast comes off and it turns out to be a problem using my hand? could they do the full repair then or is it done with once it has healed?

No,  most probably not. Once it has healed it is done. It may result in lifelong disability.

 

Operation after several days is normal procedure. 

Whether the operation is necessary or not depends solely on the X-rays.

You can show them to another doctor for a second opinion but you should ignore advice regarding operation on this forum. 

 

30000 is cheap.  If you think this is expensive you will have some nasty surprises when you get older. Get insurance!

[Formaleins]

12 minutes ago, BritManToo said:

Has most of the pain gone yet?

My broken wrist (many years back) hurt like hell the first night, then a dull ache for another three-four days, then it was just awkward in the cast for six weeks with no pain at all.

Dull pain, feels heavy but it is no where near as painful as I expected, more of a nuisance.

[BritManToo]

1 minute ago, Formaleins said:

Dull pain, feels heavy but it is no where near as painful as I expected, more of a nuisance.

That'll be gone in a couple of days, nothing that a paracetamol or two can't cure at night so you can sleep.

[Formaleins]

1 minute ago, BritManToo said:

That'll be gone in a couple of days, nothing that a paracetamol or two can't cure at night so you can sleep.

Yes, they gave me some paracetamol and also another one called Naproxen too which seems to work, I do however have a box of Tramadol if things pick up a step.

[BritManToo]

3 minutes ago, Formaleins said:

Yes, they gave me some paracetamol and also another one called Naproxen too which seems to work, I do however have a box of Tramadol if things pick up a step.

I'd stick with the paracetamol, if you can sleep.

Naproxen will give you terrible constipation for 24hrs.

Tramadol will prevent you finishing sex for 6-12hrs.

[Puwa]

Broke my arm and had it fixed at a private hospital in Chiang Mai in 2015. Three-night stay, private room,  good recovery and now 3.5 years later scar barely visible and arm works great. 65k baht.

[uhuh]

The pain subsides because the fracture is immobilized.

That does not mean the position of the fragments is good alignment.

It may be necessary to operate to get good alignment and to prevent loss of function. This depends on the X-rays.

 

BTW Naproxen is an antiinflammatory drug, it reduces painful swelling. Constipation is a typical side effect of Tramadol, less so of Naproxen.

[BritManToo]

3 minutes ago, Puwa said:

Broke my arm and had it fixed at a private hospital in Chiang Mai in 2015. Three-night stay, private room,  good recovery and now 3.5 years later scar barely visible and arm works great. 65k baht.

Broken arm is usually out patient.

Wait 6hrs since last food, x-ray, align bones, plaster and release. 8hrs maximum from start to finish.

Why ever did they keep you in three nights, if it wasn't to pad the bill?

[uhuh]

42 minutes ago, BritManToo said:

Broken arm is usually out patient.

Wait 6hrs since last food, x-ray, align bones, plaster and release. 8hrs maximum from start to finish.

Why ever did they keep you in three nights, if it wasn't to pad the bill?

He mentioned a scar. That means he had an operation. This is not done as an outpatient procedure.

 

Whether an operation was necessary depends on the X-rays. Only a very simple broken arm is a routine inpatient procedure (google Colles fracture).

What the OP describes sounds not so simple ("smashed") but we really don't know.