Wrist Fusion Surgery: What to Expect and Limitations

Hello, Director. I would like to inquire about issues related to arthrodesis?

Hello, Director Shi.
Three years ago, I suffered a wrist injury involving the distal radioulnar joint, which has resulted in chronic dislocation and pain.
X-rays show that the ulnar bone is dislocated and misaligned.
I have already undergone reconstruction of the distal radioulnar joint using the palmaris longus tendon, but within six months, it dislocated again, significantly affecting my daily life.
A hand surgeon has recommended that I undergo joint fusion surgery.
I would like to ask you about the wrist joint fusion procedure you mentioned; does the limitation in rotation refer to side-to-side movement? After the surgery, will I be completely unable to rotate my wrist left and right? I am very scared and have been hesitant to proceed with this surgery because I know it’s a lifelong decision, and if I wait until after the surgery to ask, it will be too late.
That’s why I’m reaching out for your guidance.
Thank you very much.
T_T

Shu Wei, 20~29 year old female. Ask Date: 2016/08/18

Dr. Shi Guozheng reply Orthopedics

There is a slight limitation in external rotation and internal rotation (pronation and supination).
The rotation of the wrist is not solely dependent on the wrist itself; the elbow is also involved.
Therefore, the radius and ulna can still achieve some minor rotation at the wrist joint despite their fusion.

Reply Date: 2016/08/18

More Info

Wrist fusion surgery, also known as wrist arthrodesis, is a procedure designed to alleviate pain and restore function in patients suffering from chronic wrist instability or arthritis. In your case, it seems that you have experienced chronic dislocation of the distal radioulnar joint (DRUJ) following an injury, which has significantly impacted your quality of life.

What to Expect from Wrist Fusion Surgery
1. Surgical Procedure: During wrist fusion surgery, the surgeon will remove the cartilage from the surfaces of the bones that will be fused together. This typically involves the radius and the ulna at the wrist joint. The bones are then positioned in a way that allows them to heal together, often using screws, plates, or rods to stabilize the joint during the healing process.

2. Recovery Time: Post-surgery, you can expect a recovery period that may last several months. Initially, you will likely be in a cast or splint to immobilize the wrist and allow for proper healing. Physical therapy may be necessary to regain strength and function after the fusion has healed.

3. Pain Management: Many patients report significant pain relief after the surgery, as the fusion eliminates the painful movement at the joint. However, some discomfort is expected during the recovery phase, and your healthcare team will provide guidance on pain management strategies.

Limitations After Surgery
1. Loss of Motion: One of the most significant limitations following wrist fusion surgery is the loss of motion at the fused joint. Specifically, you will lose the ability to rotate your wrist (pronation and supination) as the bones will be fused in a fixed position. This means that while you will retain some movement in your fingers and elbow, the wrist will no longer be able to rotate side to side.

2. Functional Impact: The degree to which this loss of motion affects your daily activities will depend on your specific lifestyle and needs. Many patients adapt well to the changes, especially if the fusion alleviates chronic pain and allows for more functional use of the hand.

3. Alternatives: If you are concerned about the limitations of wrist fusion, it is important to discuss alternative treatments with your surgeon. Options may include joint reconstruction, arthroscopy, or even a total wrist replacement, depending on the severity of your condition and your overall health.

Psychological Considerations
It is completely normal to feel apprehensive about undergoing wrist fusion surgery, especially considering the permanent changes it will bring. Here are some points to consider:
- Consultation: Have an in-depth discussion with your orthopedic surgeon about your concerns. Ask about the expected outcomes, potential complications, and how the surgery may impact your lifestyle. Understanding the procedure and its implications can help alleviate some of your fears.

- Second Opinion: If you are uncertain about the recommendation for surgery, seeking a second opinion from another orthopedic specialist can provide additional insights and help you make a more informed decision.

- Support System: Engage with support groups or individuals who have undergone similar procedures. Hearing about their experiences can provide reassurance and practical advice on coping with the changes.

In conclusion, wrist fusion surgery can be an effective solution for chronic wrist pain and instability, but it does come with significant limitations, particularly regarding motion. It is crucial to weigh the benefits against the potential loss of function and to have open discussions with your healthcare provider to ensure that you make the best decision for your situation.

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