Name of the Procedure:

Arthrodesis, wrist; with autograft (includes obtaining graft)

Summary

Arthrodesis of the wrist is a surgical procedure where the wrist joint is fused to alleviate pain and restore stability and function. This particular procedure involves using an autograft, meaning bone graft material is taken from another part of the patient's body.

Purpose

This procedure addresses severe wrist arthritis, trauma, or deformities that cause significant pain and impairment. The goal is to permanently fuse the bones of the wrist joint to reduce pain and improve the overall function of the hand.

Indications

• Severe osteoarthritis or rheumatoid arthritis of the wrist
• Traumatic injury or fracture that has not healed properly
• Wrist instability or deformity
• Persistent pain unresponsive to other treatments

Preparation

• Fasting for a specified period before surgery (usually after midnight)
• Discontinuing certain medications as instructed by the doctor
• Completing preoperative diagnostic tests such as X-rays, MRI, or CT scans

Procedure Description

1. The patient is given general anesthesia or a regional block to numb the area.
2. An incision is made over the wrist.
3. The damaged cartilage and bone surfaces are removed.
4. Bone graft material is harvested from another part of the patient's body, often the pelvis.
5. The graft material is shaped and placed between the wrist bones.
6. Metal plates, screws, or wires are used to hold the bones and graft in place.
7. The incision is closed with sutures, and a bandage or cast is applied to immobilize the wrist.

Duration

The procedure typically takes 2 to 3 hours.

Setting

It is performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist or anesthetist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Nonunion (failure of the bones to fuse)
• Nerve damage or blood vessel injury
• Chronic pain or stiffness
• Graft rejection or complications at the graft site

Benefits

• Significant pain reduction
• Improved stability and function of the hand
• Enhanced quality of life Benefits may be realized within a few weeks to months after surgery.

Recovery

• Immobilization of the wrist for several weeks with a splint or cast
• Gradual return to activities as healing progresses
• Physical therapy to regain strength and mobility
• Follow-up appointments to monitor healing
• Full recovery can take several months

Alternatives

• Conservative treatments like physical therapy, bracing, or medications
• Wrist joint replacement
• Less invasive procedures like wrist denervation Comparatively, arthrodesis offers a permanent solution at the expense of wrist mobility.

Patient Experience

• Patients might experience initial pain and discomfort, managed with medications.
• Swelling and bruising are common.
• Gradual reduction in pain as the bones fuse.
• Physical therapy aids in adapting to limitations and strengthens surrounding muscles.