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Wrist arthrodesis is a surgical procedure intended to reduce pain resulting from wrist arthropathy; arthritis of the wrist, particularly rheumatoid arthritis; or wrist damage due to trauma, such as a broken bone. The procedure results in the bones at the wrist joint being fused together, easing the pain caused by bone on bone contact. Wrist arthrodesis results in the loss of wrist motion, but most patients are able to adapt with the help of physical therapy and can perform most, if not all, of the activities enjoyed prior to surgery.
Patients requiring the procedure typically have been suffering from swelling of the soft tissue around the wrist, pain accompanying wrist motion, reduced functionality of the hand, and sometimes, partial deformity of the wrist and hand. The pain tends to be severe and lasting. It is common for patients to have been treated with anti-inflammatory drugs and advised to restrict wrist motion, sometimes with the use of a splint. If these treatments fail to solve the problem, it is often at that point medical professionals discover the erosion of the soft covering around the joint that is allowing bone on bone contact, typically requiring wrist arthrodesis.
There are three primary ways doctors fuse the bones of the wrist joint in wrist arthrodesis: grafting new bone on the old bones, grafting a synthetic bone on the injured area or using a pressurized plate as a fusing agent. If grafting bone, doctors typically prefer to use donated bone material as opposed to taking a graft from another part of the patient’s body; this helps to reduce the trauma associated with the surgery. Increasingly, sophisticated synthetic bone material also is available, some of which is designed to facilitate bone growth as well. Pressurized metal plates have the advantage of reducing the need for post-operative restriction of movement with splints or casts.
Following the wrist arthrodesis procedure, the patient cannot flex the wrist as was possible prior to the operation, albeit with considerable pain. Doctors typically recommend physical therapy so patients can be taught to adapt to using the hand without the accustomed wrist movement. For some types of wrist arthrodesis procedures, the first step is to keep the wrist immobilized for four to six weeks.
Many patients who have had the procedure report adapting to the loss of motion and regaining most of the hand functions previously enjoyed. It is common for gripping strength to be reduced in wrist arthrodesis patients. Activities involving inserting the hand in a narrow place also typically are more difficult because of the loss of motion.