Introduction
Fusion or arthrodesis of the wrist is a treatment for severe arthritis of the wrist not helped by simpler measures. It offers a reliable treatment for wrist pain at the cost of losing movement. Wrist arthrodesis can be complete or partial.
Indications
Painful wrist arthritis the persists despite hand therapy, splinting or corticosteroid injection.
Preoperative Instructions
Wrist fusion usually requires an overnight stay and you will be admitted on the morning of the surgery. The hospital will discuss the time of arrival and fasting arrangements. You would normally have to stop anticoagulant medication prior to this procedure but Dr Stewart can advise you about your specific requirements.
Procedure
An incision is made in the back of the wrist. The arthritic joint surfaces are removed and the wrist is fixed in position with a metal plate and screws. For a complete wrist fusion this is from the forearm to the hand, but partial wrist fusions are limited to the carpal bones within the wrist and preserve some wrist motion afterwards. Often an incision is also made in the palm to release the carpal tunnel to prevent nerve compression after the surgery.
Postoperative Instructions
The wrist is covered with a bulky dressing and plaster for 2 weeks and then a splint is used to support the wrist for another 4 weeks while the joint fuses. Hand therapy is often helpful to maintain finger and thumb movement throughout this period, and to recover strength afterwards.
Risks
Wrist fusion is a reliable procedure and complications are rare. Very occasionally the fusion may not unite requiring a further procedure to achieve bony union.
Treatment Alternatives
Ongoing splinting and pain relief is an option for those wishing to avoid surgery. In some cases, wrist arthroplasty is an option for treating arthritis and preserving motion.