eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Wrist Arthrodesis: Follow-up

Author: John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
Coauthor(s): Mark Harper, MD, Staff Physician, Department of Orthopedic Surgery, Palmetto Richland Memorial Hospital
Contributor Information and Disclosures

Updated: Jun 25, 2008

Outcome and Prognosis

Wrist arthrodesis results in a high degree of patient satisfaction with respect to pain relief and correction of deformity.23 Patients are able to accomplish most daily tasks and activities by learning to adapt to and compensate for the loss of wrist motion. After wrist arthrodesis, patients adapt to their fused wrists but still have difficulty with some activities, such as getting the hand into tight places, heavy lifting, and positioning the hand for some specific activities. However, satisfactory postoperative function appears to depend more on pain relief than on residual motion.24

Wrist arthrodesis, either pancarpal or limited, is considered the primary surgical alternative in patients with most end-stage arthritic conditions of the wrist. The pancarpal arthrodesis is a predictable durable alternative to a variety of posttraumatic, degenerative, or neoplastic conditions of the wrist. However, some authors report that complications may be prevalent. This procedure may also be modified and applied to the destroyed rheumatoid wrist.

Overall, selection of fixation mode depends on bone quality.25 With the current wide array of surgical alternatives, the surgeon must consider each case carefully and select the procedure that best applies to each particular situation. Furthermore, the surgeon must educate the patient on the limitations of each procedure.

Solid fusion, pain relief, and satisfactory functional results can be achieved following wrist arthrodesis. Prerequisites for obtaining such results are as follows: First, the patient's upper extremity level of function and range of motion of all other joints of the extremity must be assessed preoperatively, and wrist and hand deformities must be addressed radiographically. Second, during surgery, rigid fixation should be obtained and wrist deformity should be corrected. Third, a postoperative rehabilitation program should include range of motion of other joints, muscle strengthening, and functional activities.26

Future and Controversies

The current methodology and surgical technique for total wrist arthrodesis provide relatively good outcomes and are not controversial. Most controversy surrounds wrist and carpal arthroplasty and subtotal arthrodesis. The goal of subtotal arthrodesis of the wrist is to provide a stable and pain-free joint, with preservation of a limited but useful range of motion. Reported experiences indicate that the available mobility of the remaining joints that are not fused tends to increase with time and use of the extremity, and accelerated wear of these joints has not been a problem. The controversy is regarding which carpal bones need to be fused.

Wrist arthroplasty is still in its infancy. Wrist arthroplasty has been reported to have high rates of subsidence and loosening, but functional results have been acceptable. Conversion to total wrist arthrodesis is a potential salvage option for failed arthroplasty, but it is technically demanding and requires block autograft for spanning defects left by the resected implant.

 


More on Wrist Arthrodesis

Overview: Wrist Arthrodesis
Workup: Wrist Arthrodesis
Treatment: Wrist Arthrodesis
Follow-up: Wrist Arthrodesis
Multimedia: Wrist Arthrodesis
References
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References

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  2. Jebson PJ, Adams BD. Wrist arthrodesis: review of current technique. J Am Acad Orthop Surg. Jan-Feb 2001;9(1):53-60. [Medline].

  3. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am]. May 1984;9(3):358-65. [Medline].

  4. Honkanen PB, Mäkelä S, Konttinen YT, Lehto MU. Radiocarpal arthrodesis in the treatment of the rheumatoid wrist. A prospective midterm follow-up. J Hand Surg Eur Vol. Aug 2007;32(4):368-76. [Medline].

  5. Krimmer H, Wiemer P, Kalb K. [Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis]. Handchir Mikrochir Plast Chir. Nov 2000;32(6):369-74. [Medline].

  6. Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg. Feb 2006;56(2):139-44. [Medline].

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  18. Chung KC, Watt AJ, Kotsis SV. A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity. Plast Reconstr Surg. Aug 2006;118(2):433-42. [Medline].

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Further Reading

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Keywords

wrist fusion, limited intercarpal arthrodesis, limited intercarpal fusion, subtotal arthrodesis, arthropathy of the wrist, wrist joint arthritis, bone-on-bone contact between the carpal bones and the distal radius, bony consolidation, midcarpal fusion

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Contributor Information and Disclosures

Author

John J Walsh IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Carolina School of Medicine
John J Walsh IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Harper, MD, Staff Physician, Department of Orthopedic Surgery, Palmetto Richland Memorial Hospital
Mark Harper, MD is a member of the following medical societies: American Medical Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Association for Oncology, Southern California Society of Gastroenterology, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Oncology Group, Southwest Pediatric Nephrology Study Group, Southwestern Association of Clinical Microbiology, Southwestern Surgical Congress, Special Operations Medical Association, State Medical Society of Wisconsin, Surgical Infection Society, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Teratology Society, Texas Medical Association, Texas Orthopaedic Association, Texas Pediatric Society, Texas Society of Plastic Surgeons, Trauma Association of Canada, Turkish Society for Parasitology, and US Virgin Islands Medical Society
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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