Partial Wrist Fusion
Which conditions is it for?
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When some joints in a wrist is still in good condition
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But others are worn out (bone on bone)
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–Due to previous united fracture
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–Or longstanding ligamentous injuries
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The useful joints can be maintained and worn joints eliminated
One example is a four-corner fusion
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In this surgery the worn and or broken scaphoid bone is removed
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and the remaining bones are fused to facilitate a stable wrist
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Bone graft is often needed from the iliac crest (hip)
What else can be done for an arthritic wrist?
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Avoid activities that flares up pain in the wrist.
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Wear a wrist splint.
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Consider taking an anti inflammatory and panadol.
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A steroid injection into the can give temporary relief
When is surgery needed?
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When non operative treatment is unsuccessful and
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Symptoms in the hand:
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–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
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–and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read.
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If you would prefer a definitive cure for the problem.
How does surgery work?
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This kind of surgery is usually done under general anaesthetic
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Because it is painful after surgery and significant swelling can occur (that may need urgent treatment), it is advisable to stay in hospital overnight
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Antibiotics is usually administered at the time of surgery, but does not have to be continued after.
What do we do in surgery?
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An incision is made on the back of the wrist
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The worn out bones are removed
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And the remaining cartilage between the other bones are removed
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The defect is filled with bone that is harvested from the pelvis
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And the bones are fixed with a plate or screws
After the Surgery
In Hospital
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A large bandage and splint is applied to the hand.
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It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
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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.
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If the bandage feels too tight, do not hesitate to ask for it to be removed.
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At Home
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Continue to elevate your arm until swelling in your fingers subside.
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Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).
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Keep the wound dry covered and clean.
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Remove the bulky bandage 2 days after surgery, but keep the splint on.
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Blood thinning medication (if you are on any) can be started 2 days after surgery
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An appointment usually arranged with a hand therapist at about 1-2 weeks after surgery.
The recovery
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The wound usually heals over 1-2 weeks and any sutures are then removed
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Self care (washing, dressing, eating) with the operated hand – usually around 5 days (with a splint on)
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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)
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Most moderate activities(equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 4-6 weeks,
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The bone in the wrist usually take about 8-12 weeks to knit.
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Heavy manual activities should be avoided for 3-6 months
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A maximal recovery can take 6-12 months.
What can go wrong?
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Infection occurs rarely (1% of the time). It is rarely severe.
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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.
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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.
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Occasionally the bones do not fuse and further surgery may be needed.
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Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.
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Rarely, the fusion can be unsuccessful and a total wrist arthro desis may be needed.
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A anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.
What can you expect the final outcome to be?
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Usually around 50% of wrist movement is maintained
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Strength in the hand is usually around 80 % of normal.
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Most patients experience a satisfactory outcome for many years (studied to about 20 years)