Wrist Arthrodesis

Wrist arthrodesis is a salvage procedure to provide the patient with pain free immobile wrist in maximum functional position. Arthrodesis means fusion of the bones.

After arthrodesis or fusion, motion between worn joints is eliminated and so is pain.

Indications

As noted before, wrist joint is a salvage procedure. Because it needs to sacrifice motion, other options of treatment must be considered and discussed with patient wherever feasible.

-Wrist arthropathy from any cause where pain is not responding to nonoperative measures. Causes of wrist arthropathy may be

• Trauma
• Rheumatoid arthritis
• Crystalline arthropathy
• Carpal instability
• Tumors
• Septic arthritis
• Mechanical overuse
• Scaphoid nonunion

– For stabilization of the wrist when combined with tendon transfers

– Correction of wrist deformities in patients with spastic hemiplegia

– Salvage of unsuccessful wrist arthroplasty

– Previous, unsuccessful, more limited arthrodesis

– Reconstruction of wrist in

• Segmental tumor resection
• Infection
• Traumatic bone loss of the distal radius and carpus

Procedure of Arthrodesis

Using a dorsal incision and bone graft following joints are fused

• Radioscaphoid
• Radiolunate
• Scaphocapitate
• Capitate-lunate
• Capito-trapezoid
• Third carpometacarpal joints.

Compression plate is used to fix the fusion and spans from  third metacarpal to distal radius. Wris is generally fused in 10 degrees of dorsiflexion.

Lunotriquetral, capitate-hamate, triquetrum-hamate [ulnar sided joints] are fixed if there is significant arthrits in these joints at time of operation.

Contraindications

• Quadriparetics who use modified grasp and transfer techniques
• Major sensory deprivation in the hand

Complications

• Extensor tendon adhesions
• Plate tenderness forcing  implant removal.
• Pseudarthrosis- A failure of fusion resulting in false joint
• Neuroma
• Fracture of healed fusion.
• Carpal tunnel syndrome
• Reflex sympathetic dystrophy
• Poor wound Healing
• Persistent unexplained pain

Outcome

Wrist arthrodesis provides good pain relief  and correction of deformity. Patients can perform most of the activities of daily living. Problem is experienced in negotiating hand in tight spaces and executing some positions of the hand.