Wrist Arthrodesis – Indications and Procedure

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

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

Indications

• Wrist arthropathy not responding to conservative treatment
  • 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 the 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.

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

Lunotriquetral, capitate-hamate, triquetrum-hamate [ulnar sided joints] are fixed if there is significant arthritis in these joints at the 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 a 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 the 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.