Post-Operative Complications of Distal Radioulnar Fusion Surgery

Complications after remote distal radioulnar joint fusion?

Hello Doctor, I have a distal radius and ulnar fracture with joint involvement, and after a delay of three months in treatment, it healed improperly before I went to the hospital for surgery.
After two months of rehabilitation post-surgery, I found that I still cannot rotate or flex my wrist.
I consulted another hospital, and the doctor indicated that I need corrective surgery, specifically a distal radius and ulnar fusion.
What are the potential complications after the surgery? Will I be able to bear weight? Will I be able to exert force? What adverse effects might I experience? Please help me with these questions.

Mr. Tang, 30~39 year old female. Ask Date: 2015/12/11

Dr. Shi Guozheng reply Orthopedics

After the fusion surgery of the distal radius and ulna, there may be a slight reduction in joint mobility; however, weight-bearing and strength are still possible.
Most importantly, this procedure can reduce pain and improve function.

Reply Date: 2015/12/11

More Info

Post-operative complications following distal radioulnar fusion surgery can vary based on individual circumstances, the extent of the initial injury, and the surgical technique employed. Given your history of a distal radius fracture with associated ulnar dislocation and subsequent malunion, it is understandable that you are concerned about the potential outcomes of the corrective surgery.

Common Post-Operative Complications
1. Infection: As with any surgical procedure, there is a risk of infection at the surgical site. This can lead to delayed healing or more severe complications if not addressed promptly.

2. Nonunion or Malunion: Although the goal of the surgery is to achieve a stable fusion of the distal radioulnar joint, there is a possibility that the bones may not fuse properly (nonunion) or may heal in an incorrect position (malunion), which could necessitate further surgical intervention.

3. Stiffness and Loss of Range of Motion: After surgery, it is common to experience stiffness in the wrist and forearm. This can limit your ability to rotate (pronate and supinate) the forearm and flex the wrist. Physical therapy is often required to regain as much motion as possible.

4. Nerve Injury: There is a risk of nerve injury during surgery, particularly to the ulnar nerve, which can lead to numbness, tingling, or weakness in the hand.

5. Hardware Complications: If plates or screws are used to stabilize the joint, there is a risk of hardware failure or irritation, which may require removal.

6. Complex Regional Pain Syndrome (CRPS): This is a rare but serious condition that can occur after surgery, characterized by prolonged pain, swelling, and changes in skin color and temperature in the affected limb.

Functional Outcomes
Regarding your specific questions about functionality post-surgery:
- Weight Bearing: After distal radioulnar fusion, the ability to bear weight on the wrist will depend on the healing process and the surgeon's recommendations. Typically, patients are advised to avoid heavy lifting or weight-bearing activities for a certain period post-surgery, often several weeks to months, until the fusion is confirmed to be stable.

- Strength and Power: You may experience a reduction in strength and power in the wrist and forearm after the surgery. Rehabilitation and physical therapy are crucial to help regain strength and function. However, some patients may find that their ability to perform certain tasks, especially those requiring full wrist motion, is limited after fusion.

- Long-term Effects: The long-term impact of distal radioulnar fusion can include altered biomechanics of the wrist, which may lead to increased stress on adjacent joints, potentially resulting in arthritis over time. It is essential to discuss these risks with your surgeon to understand how they may apply to your specific situation.

Recommendations
1. Follow-Up Care: Regular follow-up appointments with your orthopedic surgeon are vital to monitor the healing process and address any complications early.

2. Physical Therapy: Engaging in a structured rehabilitation program can significantly improve your outcomes. A physical therapist can guide you through exercises tailored to regain strength and range of motion.

3. Lifestyle Modifications: Depending on the extent of your recovery, you may need to modify certain activities to accommodate any limitations in wrist function.

4. Patient Education: Understanding the nature of your surgery and the expected outcomes can help set realistic goals for your recovery.

In summary, while distal radioulnar fusion surgery can be effective in addressing issues related to malunion and instability, it is essential to be aware of the potential complications and functional limitations that may arise. Open communication with your healthcare team will be crucial in navigating your recovery and achieving the best possible outcome.

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