What is it?
Wrist fusion (or arthrodesis) is an operation in which the moving surfaces of the wrist are removed in order to fuse those joints together. This will be helped by packing bone graft around the joints. A specially designed plate and screws (or occasionally a metal pin) will be used to stabilise the bones while they heal. The bone graft is taken from either the wrist area or the pelvis/hip bone. Taking bone from the hip region does not harm the bone or nearby joints, but can be quite sore for a few days.
When is it required?
Wrist fusion is usually performed for severe widespread arthritis of the wrist which is associated with pain. Arthritis leads to the destruction of the normally slippery articular cartilage found at the ends of bones. This articular cartilage allows smooth movements of joints without pain or friction. Once this articular surface is lost, as occurs in arthritis, the ends of the bones are exposed. Now, rather than smooth movements, the surfaces are rough. Pain and loss of movement can occur as a result.
The operation is performed under Regional and/or General Anaesthetic. You will be admitted overnight following your surgery. A bulky dressing, which includes a Plaster of Paris, is applied to the hand and wrist. The arm should be kept elevated as much as possible to reduce swelling. Movement of all the joints that are not immobilised is essential to prevent stiffness.
You will be seen in the outpatient department approximately two weeks following your operation. The wound will be checked and your dressing changed. Another splint or Plaster of Paris will be applied. The wrist will need to be protected until the bones have fused.
At six weeks, an X-ray will be taken to see whether the bones have joined. A removable splint may be applied at this stage. Rehabilitation of the wrist will be guided by our Hand Therapy team. Solid union may not occur for approximately three months following your surgery.
Are there any alternatives?
There are a number of surgical options for painful wrist arthritis that is not controlled by painkillers and/or splints. Your surgeon will assess the severity of your symptoms and arthritis and discuss with you which treatment is most appropriate.
This operation involves removing the small nerves that supply sensation to the wrist joint. This will have no detrimental effect to the sensation to the hand/fingers. This procedure can provide benefit, relieving pain, in patients for several years.
Partial wrist fusion:
In some cases, where only part of the wrist is arthritic, only part of the wrist is fused together. Some of the wrist bones are also removed. This operation maintains some of the wrist movement (approximately half). This operation is however only appropriate in a small number of people.
Proximal Row Carpectomy:
This operation involves removing the nearside row of the wrist bones. This is again only appropriate for some patients in which the other articular surfaces are healthy. Again this procedure will maintain some wrist movement.
Wrist replacement surgery is generally reserved for patients with Inflammatory arthritis such as Rheumatoid and Psoriatic arthritis. (see Wrist Replacement)