Arthritis is a disease that ultimately destroys the articular cartilage of the joints. The normal cartilage between two bones is destroyed, exposing the bones and causing a rubbing of the surfaces, in turn causing what can be severe pain.
Other common names
Who does it affect?
Arthritis can occur in a wrist due to an injury e.g. a fracture that that has healed with a step, causing localised wear and tear. It can also be part of the aging process and be down to general wear and tear.
Patients often complain of pain and a reduced range of movement in the wrist, often restricting normal daily activities. It is likely to be painful to lift with or bend the wrist.
A wrist fusion is used to control pain in an arthritic wrist. Arthritis can affect anyone and is caused through a variety of reasons from trauma / injury to generalised wear and tear.
You consultant will normally be able to diagnose the condition through visual examination of the swollen wrist and by testing the range of movement. X-rays may be performed to confirm the diagnosis and in exceptional circumstances, an MRI may be required for detailed understanding.
Before proceeding to treatment, your wrist may be splinted or you may be offered steroid injections. These injections may occasionally be given with the aid of x-ray guidance.
Surgery for wrist fusion
There are two main types of fixation for wrist fusions. The first is a contoured plate that is held across the back of the wrist joint, with screws into the bone to secure fixation. Having secured the plate, your consultant will remove the remaining articular cartilage from the wrist joint, allowing the bone to completely solidify underneath the plate.
The second type of fixation is a pin that is passed across the wrist joint and normally down through the middle knuckle joint.
If a plate fixation is used then often no post-surgical immobilisation is required, and you are advised to move your fingers as soon as possible. Swelling is common after surgery and it is advisable to elevate the hand for the first few weeks after surgery. If a pin fixation has been used then this may be supplemented with plaster of Paris for four to six weeks until the underlying bones have solidly united.
Heavy loading activities should be avoided until the bone has completely solidified.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (< 1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- The main risk is that of non-union, whereby the bone ends fail to completely grow over. This will eventually cause the metalwork to fail and the operation may need to be repeated.