Name of the Procedure:

Arthrodesis, wrist; with sliding graft
(Commonly known as wrist fusion with bone graft)

Summary

This procedure involves fusing the bones in the wrist joint together using a bone graft to alleviate pain and improve stability and function in affected wrists, usually due to severe arthritis or injury.

Purpose

The primary purpose of wrist arthrodesis with a sliding graft is to relieve chronic pain and enhance wrist stability by permanently joining the wrist bones, thereby eliminating movement between them.

Indications

• Severe arthritis (osteoarthritis, rheumatoid arthritis)
• Post-traumatic arthritis
• Avascular necrosis (death of bone tissue due to lack of blood supply)
• Instability or deformity in the wrist
• Failed previous wrist surgery

Preparation

• Fasting for at least 6-8 hours prior to surgery
• Adjusting or stopping certain medications as recommended by the physician
• Undergoing any necessary preoperative diagnostic tests (e.g., X-rays, blood tests)
• Consulting with the surgical team for a pre-surgical assessment and planning

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: An incision is made on the back of the wrist to access the joint.
3. Bone Preparation: Damaged or arthritic cartilage is removed from the wrist bones to create a raw surface for the graft.
4. Harvesting the Graft: A bone graft is taken from another site, often the pelvis, using a separate incision.
5. Sliding the Graft: The harvested bone graft is shaped and placed between the wrist bones.
6. Fixation: Metal plates, screws, or pins are used to hold the bones and graft in place, ensuring proper alignment and fusion.
7. Closure: The surgical site is closed with sutures or staples, and a bandage or splint is applied to maintain wrist stability.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

Wrist arthrodesis with sliding graft is usually performed in a hospital or specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Nonunion or delayed union of the fused bones
• Hardware complications (e.g., screws becoming loose)
• Nerve damage resulting in numbness or weakness
• Reduced range of motion and potential loss of wrist mobility
• Pain and swelling around the surgical area

Benefits

• Significant pain relief
• Improved wrist stability and function
• Enhanced ability to perform daily activities
• Reduction in the need for pain medication

Recovery

• Immediate post-procedure care involves monitoring and pain management in a recovery room.
• Wearing a cast or splint for up to 12 weeks to ensure proper healing.
• Engaging in physical therapy to restore strength and function.
• Full recovery may take between 6 to 12 months.
• Avoid heavy lifting and strenuous activities during the recovery period.
• Regular follow-up appointments to monitor healing progress.

Alternatives

• Pain management with medications or injections
• Physical therapy and occupational therapy
• Wrist arthroscopy for less invasive intervention
• Total wrist replacement surgery
• Pros: Less invasive options can provide temporary relief without the permanence of fusion.
• Cons: Non-fusion options might not provide lasting relief or stability in severe cases.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperative discomfort can be managed with prescribed pain medication. Patients may experience initially limited mobility and will need to follow rehabilitation protocols to regain strength and function.