Name of the Procedure:

Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)

Summary

Arthrodesis of the wrist is a surgical procedure where the wrist joint (including radiocarpal, intercarpal, and carpometacarpal joints) is fused to create one solid bone, providing stability and alleviating pain. This particular procedure is done without the use of a bone graft.

Purpose

Arthrodesis is performed to:

• Relieve chronic, debilitating pain in the wrist joint.
• Restore stability and improve function when other treatments have failed.
• Correct deformities caused by conditions like arthritis.

Indications

• Severe arthritis (rheumatoid, osteoarthritis, or post-traumatic arthritis) in the wrist.
• Chronic wrist pain not relieved by conservative treatments (e.g., medications, physical therapy).
• Wrist deformities or instability.
• Non-reparable wrist fractures.

Preparation

• Patients may need to fast for a certain period before the surgery.
• Temporary cessation of certain medications may be required.
• Pre-operative assessments could include X-rays, MRIs, and blood tests.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made over the wrist.
3. Joint Preparation: Cartilage from the wrist joints is removed.
4. Fusion: The wrist bones are aligned and fused together using metal hardware such as plates and screws.
5. Closure: The incision is closed with sutures or staples and the wrist is bandaged and immobilized.

Duration

• Typically takes 2-3 hours.

Setting

• Usually performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the surgical site.
• Non-union or delayed union of the bones.
• Hardware complications (e.g., hardware failure or irritation).
• Reduced wrist mobility and flexibility.
• Pain at the fusion site.

Benefits

• Significant reduction in wrist pain.
• Improved functionality and ability to perform daily activities.
• Enhanced wrist stability.

Recovery

• Patients may need to keep the wrist immobilized in a splint or cast for 6-8 weeks.
• Pain management with prescribed medications.
• Gentle physical therapy may be recommended once initial healing has occurred.
• Full recovery can take several months, with follow-up appointments to monitor progress.

Alternatives

• Non-surgical treatments like medication, wrist braces, and physical therapy.
• Arthroplasty (wrist joint replacement).
• Corticosteroid injections.
• Pros and cons: Non-surgical treatments offer temporary relief and less risk but may not be effective long-term. Arthroplasty retains some wrist movement but carries its own set of risks.

Patient Experience

• Patients will feel numb or asleep during the surgery due to anesthesia.
• Post-surgery, they may experience pain and discomfort managed with prescribed medications.
• Initial immobilization might be uncomfortable but necessary for proper healing.
• Gradual return to normal activities as advised by the surgeon.