Our Summary

This research paper is about a surgical procedure called total wrist arthrodesis, which is done to improve hand function by reducing pain and improving grip strength. This surgery is recommended for individuals who have severe damage in their wrist joints causing pain. However, it isn’t recommended for those who have good hand function after other treatments or if they have a chronic joint infection.

The procedure involves making an incision at the back of the wrist, removing damaged joint surfaces, and filling the gaps with bone grafts from the patient’s radius (bone in the forearm) or the hip bone. After the surgery, the wrist is immobilized using a cast for two weeks. Patients are encouraged to move their fingers immediately after surgery and regular X-ray checks are done for up to 6 weeks post-surgery.

The study followed up with 28 patients who underwent this procedure. They found that grip strength improved in these patients after surgery and pain levels significantly decreased. Most of the patients were satisfied with the treatment and achieved successful healing of the bone. However, some patients experienced complications such as non-healing of the bone (nonunion), pain in the joints of the hand, screw breakage, bleeding, and infection. These complications were managed with further treatments such as removal of the plate, additional bone grafts, and removal of protruding screws.

In conclusion, total wrist arthrodesis can be a beneficial treatment for individuals with severe wrist joint damage, improving hand strength and reducing pain. However, potential complications need to be considered and managed appropriately.

FAQs

  1. Who is the total wrist arthrodesis procedure recommended for?
  2. What does the total wrist arthrodesis procedure involve and what is the recovery process like?
  3. What were the results and potential complications of the study on total wrist arthrodesis?

Doctor’s Tip

A doctor may advise a patient undergoing joint fusion surgery to follow post-operative care instructions carefully, including keeping the wrist immobilized as directed, moving the fingers gently to prevent stiffness, and attending follow-up appointments for monitoring healing and addressing any complications. They may also recommend physical therapy to help regain strength and function in the hand following surgery. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support overall healing and recovery after joint fusion surgery.

Suitable For

Typically, patients who are recommended for joint fusion procedures such as total wrist arthrodesis are those who:

  1. Have severe damage in their wrist joints causing chronic pain that does not respond to conservative treatments such as medication, physical therapy, or injections.
  2. Have limited or poor hand function due to wrist joint damage.
  3. Have failed previous surgical interventions to address wrist joint issues.
  4. Have conditions such as rheumatoid arthritis, osteoarthritis, or post-traumatic arthritis affecting the wrist joint.
  5. Are willing to undergo a surgical procedure and commit to post-operative rehabilitation to maximize the benefits of joint fusion.

It is important for patients to have a thorough evaluation by a healthcare provider specializing in orthopedic surgery to determine if they are suitable candidates for joint fusion procedures. Additionally, patients should be informed about the potential risks and benefits of the surgery and have realistic expectations about the outcomes.

Timeline

  • Before surgery:
  1. Patient experiences severe wrist joint pain and limited hand function.
  2. Consultation with a surgeon to discuss treatment options.
  3. Decision to undergo total wrist arthrodesis surgery.
  4. Pre-operative preparations and tests.
  5. Surgery performed to remove damaged joint surfaces and fill gaps with bone grafts.
  • After surgery:
  1. Wrist immobilized with a cast for two weeks.
  2. Encouraged to move fingers immediately after surgery.
  3. Regular X-ray checks for up to 6 weeks post-surgery.
  4. Improvement in grip strength and reduction in pain levels observed.
  5. Some patients may experience complications such as nonunion, joint pain, screw breakage, bleeding, and infection.
  6. Complications managed with additional treatments such as removal of plate, bone grafts, and screw removal.
  7. Successful healing of the bone and overall satisfaction with treatment reported by most patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about joint fusion include:

  1. What are the benefits of total wrist arthrodesis in improving my hand function and reducing pain?
  2. What are the potential risks and complications associated with this surgery?
  3. How long is the recovery period after total wrist arthrodesis and what can I expect during this time?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What is the success rate of total wrist arthrodesis in patients with similar conditions to mine?
  6. Are there any alternative treatments or procedures that I should consider before deciding on joint fusion?
  7. How long will the bone take to heal completely after the surgery?
  8. What can I do to reduce the risk of complications during the recovery period?
  9. Will I need to have any follow-up appointments or tests after the surgery?
  10. How soon will I be able to return to my normal activities and work after total wrist arthrodesis?

Reference

Authors: Köhler S, Koch K, Arsalan-Werner A, Mehling IM, Seegmüller J, Krimmer H, Sauerbier M. Journal: Oper Orthop Traumatol. 2017 Oct;29(5):416-430. doi: 10.1007/s00064-017-0517-5. Epub 2017 Sep 12. PMID: 28900671