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Total Wrist Replacement

Partial Wrist Fusion

Which conditions is it for?

Which condition

  • When some joints in a wrist is still in good condition

  • But others are worn out (bone on bone)

    • –Due to previous united fracture

    • –Or longstanding ligamentous injuries

  • The useful joints can be maintained and worn joints eliminated

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One example is a four-corner fusion

  • In this surgery  the worn and or broken scaphoid bone is removed

  • and the remaining bones are fused to facilitate a stable wrist

  • Bone graft is often needed from the iliac crest (hip)

Four-Corner
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What else can be done for an arthritic wrist?

  • Avoid activities that flares up pain in the wrist.

  • Wear a wrist splint.

  • Consider taking an anti inflammatory and panadol.

  • A steroid injection into the can give temporary relief

What else can be done?

When is surgery needed?

  • When non operative treatment is unsuccessful and

  • Symptoms in the hand:

    • –stop you from doing the ‘things that you have to do’  such as getting dressed, making a meal, driving a car, or getting a good night’s sleep

    • –and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read.

  • If you would prefer a definitive cure for the problem.

When is surgery needed?

How does surgery work?

  • This kind of surgery is usually done under general anaesthetic

  • Because it is painful after surgery and significant swelling can occur (that may need urgent treatment), it is advisable to stay in hospital overnight

  • Antibiotics is usually administered at the time of surgery, but does not have to be continued after.

How does surgery work

What do we do in surgery?

  • An incision is made on the back of the wrist

  • The worn out bones are removed

  • And the remaining cartilage between the other bones are removed

  • The defect is filled with bone that is harvested from the pelvis

  • And the bones are fixed with a plate or screws

What do we do in surgery?
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After the Surgery

In Hospital

  • A large bandage and splint is applied to the hand.

  • It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling

  • Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’,  than ‘to catch’ up when it is severe.

  • If the bandage feels too tight, do not hesitate to ask for it to be removed.

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At Home

  • Continue to elevate your arm until swelling in your fingers subside.

  • Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).

  • Keep the wound dry covered and clean.

  • Remove the bulky bandage 2 days after surgery, but keep the splint on.

  • Blood thinning medication (if you are on any) can be started 2 days after surgery

  • An appointment usually arranged with a hand therapist at about 1-2 weeks after surgery.

After the surgery

The recovery

  • The wound usually heals over 1-2 weeks and any sutures are then removed

  • Self care (washing, dressing, eating) with the operated hand – usually around 5 days (with a splint on)

  • Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 4-6 weeks)

  • Most moderate activities(equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 4-6 weeks,

  • The bone in the wrist usually take about 8-12 weeks to knit.

  • Heavy manual activities should be avoided for 3-6 months

  • A maximal recovery can take 6-12 months.

The recovery

What can go wrong?

  • Infection occurs rarely (1% of the time). It is rarely severe.

  • There may be ongoing pain from scarring other worn out joints in the area, that were not obviously a problem at the time of doing the surgery.

  • Very rarely severe swelling can occur that threatens the blood supply or nerves in the hand. This can necessitate urgent surgery to release the pressure.

  • Occasionally the bones do not fuse and further surgery may be needed.

  • Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.

  • Rarely, the fusion can be unsuccessful and a total wrist arthro desis may be needed.

  • A anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

What can go wrong?

What can you expect the final outcome to be?

What can you expect?

  • Usually around 50% of wrist movement is maintained

  • Strength in the hand is usually around 80 % of normal.

  • Most patients experience a satisfactory outcome for many years (studied to about 20 years)

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