Wrist fusion surgery, or wrist arthrodesis, is a procedure that joins the bones in the wrist.
Often, the surgery is done to treat severe wrist arthritis or injuries. It’s typically done when other nonsurgical treatments have failed to help the condition.
A wrist fusion surgery might involve part of the wrist or the entire wrist. In either case, the goal is to reduce pain and increase the strength of your grip.
Read on to learn about the different types of wrist fusion surgery and what happens during the procedure.
Wrist fusion surgery is mainly used to treat severe arthritis. This includes:
The procedure is also used to treat:
A wrist fusion surgery has several potential benefits. These include:
- pain relief
- improved grip strength
- increased wrist stability
A wrist fusion, like all procedures, is associated with risks and side effects:
Since wrist arthrodesis fuses your wrist joint, it will not flex or extend as usual. In turn, you’ll have limited wrist mobility and function.
Reduced grip strength
Although wrist fusion can improve grip strength, it may also have the opposite effect. This can further limit the function of your wrist.
Wrist fusion scars
During the procedure, your surgeon will make an incision in your skin to access your wrist joint. This will likely leave a scar.
Swelling after surgery
It’s normal to experience swelling right after wrist fusion. This a natural part of the healing process.
If bacteria enter the incision during surgery or recovery, an infection may develop. Risk factors for developing an infection include:
- older age
- compromised immune system
- kidney disease
- smoking cigarettes
- previous surgery
- prior trauma
All surgeries present the risk of excessive bleeding. If you have a high risk for bleeding, your surgeon will take additional steps to prevent it.
Bones failing to fuse
If the wrist bones fail to fuse together, it’s called a nonunion. This causes continued pain after surgery and requires another surgery to correct.
If a nearby nerve is injured during the surgery, it can lead to nerve problems like carpal tunnel syndrome or weakness in the hand.
It’s possible for the metal hardware to break or become loose. If this occurs, you may need a second surgery to replace the hardware.
It’s very rare but possible to develop an allergic reaction to the hardware used in wrist fusion. If this occurs, a second surgery might be necessary to remove the hardware.
Although there are several types of wrist fusion surgery, the general steps are the same:
Before the procedure
In the weeks before surgery, your surgeon will use different tests to plan your procedure:
If necessary, they’ll take extra steps to reduce complications. For example, they might prescribe antibiotics if you’re at risk of infection.
You’ll be given anesthesia just before surgery begins.
During the procedure
Generally, here’s what happens during wrist fusion:
- Your surgeon sanitizes the surgical site.
- Next, they make an incision on your wrist to expose the joint.
- Using surgical tools, they adjust ligaments and remove cartilage.
- Your wrist is placed in a specific position to maximize grip strength.
- Your surgeon aligns the bones and then fuses them together with plates and screws.
- Your surgeon closes the wound with stitches and applies a wound dressing.
After the surgery
Once the wound is closed, your medical team will place a brace or cast around your wrist to minimize movement. They’ll also give you medication to manage the pain.
Before you go home, your surgeon will explain how to care for the wound.
Wrist fusion can be total or partial. Total wrist fusion involves the entire wrist, while partial wrist fusion involves part of the wrist.
From there, there are many types of wrist fusion surgery. The most common techniques include:
There are two joints in the wrist. The radiocarpal joint connects the radius bone (in the arm) to the first row of carpal bones (in the hand). The midcarpal joint connects the first and second rows of carpal bones.
Radio-scapho-lunate fusion is used when you have arthritis in the radiocarpal joint but not in the midcarpal joint. This typically happens after fractures in the radius bone.
This technique is often used to treat rheumatoid arthritis and instability in certain parts of the wrist, including the midcarpal joint. It’s not recommended for wrist issues caused by Kienbock’s disease.
Scapho-luno-capitate fusion is used when you have midcarpal arthritis but a healthy radiocarpal joint. It can also be used to treat wrist instability due to Kienbock’s disease.
The surgery involves fusing the bones in the midcarpal joint. Since the area is large, it has a high fusion rate. However, it also significantly limits movement.
This technique is used to treat arthritis in the scaphotrapeziotrapezoid (STT) joint. The STT joint connects the trapezium, trapezoid, and scaphoid bones, which are at the base of your thumb.
It can also treat wrist instability caused by Kienbock’s disease.
Four-corner fusion with scaphoid excision
Four-corner fusion with scaphoid excision is commonly used for the advanced stages of severe arthritis. It’s a partial wrist fusion that preserves some movement and grip strength.
Commonly, this surgery is done with Herbert screws. It can also be done with a circular plate.
It can take about 3 months to recover from wrist fusion.
Right after surgery, you’ll need to avoid placing weight on your wrist for about 2 weeks. You’ll also need to wear a brace during this time.
After 2 weeks, you’ll go to the doctor for a checkup. They’ll remove your stitches and examine your wrist to ensure it’s healing properly. You might also start therapy at this time.
After week 6, you’ll visit your doctor for another checkup.
Wrist fusion surgery is best for people who have severe wrist arthritis that has failed to respond to treatment. This includes treatments like:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- corticosteroid injections
- topical pain relievers
On the other hand, the surgery is not recommended for people who:
- have mild or moderate wrist arthritis
- have not yet tried all nonsurgical treatments
- need to maintain wrist mobility for work
According to a 2017 study in the Journal of Hand Surgery, partial wrist fusion costs
The exact cost will depend on your location and surgeon.
Wrist fusions are only done when medically necessary. This means your health insurance provider should cover some or all of the costs if the procedure meets this requirement.
If you don’t have health insurance, ask your surgeon if they offer a payment plan. Although this won’t decrease your total cost, it may be easier to pay for the procedure in smaller portions.
You can also ask your doctor about any available programs that offer financial assistance.
A wrist fusion is not the only choice for severe wrist arthritis. Alternatives include:
- Wrist arthroplasty. Also known as a wrist replacement, this surgery involves joint implant. It maintains wrist mobility, unlike wrist fusion.
- Proximal row carpectomy. In this procedure, a surgeon removes some of the carpal bones near the forearm. This can help reduce pain and maintain some mobility.
Your doctor can determine which surgery is the best option for your condition.
Typically, wrist fusion surgery can relieve wrist pain. More than
If you experience non-union, you’ll likely need a second wrist fusion procedure. You may also need a second surgery if the hardware breaks or causes irritation.
Wrist fusion surgery permanently fuses the bones in the wrist. It can relieve wrist pain caused by severe wrist arthritis, wrist injuries, or genetic disorders. The procedure can also stabilize your wrist.
However, the procedure significantly limits wrist mobility. This can be an issue if you want to maintain wrist movement as much as possible. Your doctor can determine if wrist fusion is right for you.
After surgery, you’ll need to wear a cast or brace for 2 weeks. It takes about 3 months to fully recover.