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Total Wrist Replacement

Partial Wrist Fusion

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  • When some joints in a wrist is still in good condition

  • But others are worn out (bone on bone)

    • –Due to previous united fracture

    • –Or longstanding ligamentous injuries

  • The useful joints can be maintained and worn joints eliminated

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  • In this surgery  the worn and or broken scaphoid bone is removed

  • and the remaining bones are fused to facilitate a stable wrist

  • Bone graft is often needed from the iliac crest (hip)

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  • Avoid activities that flares up pain in the wrist.

  • Wear a wrist splint.

  • Consider taking an anti inflammatory and panadol.

  • A steroid injection into the can give temporary relief

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  • When non operative treatment is unsuccessful and

  • Symptoms in the hand:

    • –stop you from doing the ‘things that you have to do’  such as getting dressed, making a meal, driving a car, or getting a good night’s sleep

    • –and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read.

  • If you would prefer a definitive cure for the problem.

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  • This kind of surgery is usually done under general anaesthetic

  • Because it is painful after surgery and significant swelling can occur (that may need urgent treatment), it is advisable to stay in hospital overnight

  • Antibiotics is usually administered at the time of surgery, but does not have to be continued after.

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  • An incision is made on the back of the wrist

  • The worn out bones are removed

  • And the remaining cartilage between the other bones are removed

  • The defect is filled with bone that is harvested from the pelvis

  • And the bones are fixed with a plate or screws

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In Hospital

  • A large bandage and splint is applied to the hand.

  • It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling

  • Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’,  than ‘to catch’ up when it is severe.

  • If the bandage feels too tight, do not hesitate to ask for it to be removed.

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At Home

  • Continue to elevate your arm until swelling in your fingers subside.

  • Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).

  • Keep the wound dry covered and clean.

  • Remove the bulky bandage 2 days after surgery, but keep the splint on.

  • Blood thinning medication (if you are on any) can be started 2 days after surgery

  • An appointment usually arranged with a hand therapist at about 1-2 weeks after surgery.

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  • The wound usually heals over 1-2 weeks and any sutures are then removed

  • Self care (washing, dressing, eating) with the operated hand – usually around 5 days (with a splint on)

  • Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 4-6 weeks)

  • Most moderate activities(equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 4-6 weeks,

  • The bone in the wrist usually take about 8-12 weeks to knit.

  • Heavy manual activities should be avoided for 3-6 months

  • A maximal recovery can take 6-12 months.

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  • Infection occurs rarely (1% of the time). It is rarely severe.

  • There may be ongoing pain from scarring other worn out joints in the area, that were not obviously a problem at the time of doing the surgery.

  • Very rarely severe swelling can occur that threatens the blood supply or nerves in the hand. This can necessitate urgent surgery to release the pressure.

  • Occasionally the bones do not fuse and further surgery may be needed.

  • Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.

  • Rarely, the fusion can be unsuccessful and a total wrist arthro desis may be needed.

  • A anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

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  • Usually around 50% of wrist movement is maintained

  • Strength in the hand is usually around 80 % of normal.

  • Most patients experience a satisfactory outcome for many years (studied to about 20 years)

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