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What is Arthroscopic Partial Wrist Fusion?

Arthroscopic partial wrist fusion is a minimally-invasive surgery that uses tiny incisions to immobilize selected bones of the wrist. The wrist joint is one of the most complex joints in the human body. It is made up of carpal bones and the two bones of the forearm: the radius and ulna. The carpal bones are eight separate small bones supported by connecting ligaments that join the hand to the forearm. These bones are:

  • Scaphoid
  • Lunate
  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
  • Pisiform
  • Triquetrum

Certain disorders or trauma can cause degeneration or dislocation of the wrist bones resulting in severe pain and disability. Partial wrist fusion is a salvage procedure to relieve pain, preserve joint motion and increase wrist function.

Indications for Arthroscopic Partial Wrist Fusion

It is indicated for:

  • Degenerative wrist osteoarthritis
  • Kienbock’s Disease due to avascular necrosis (tissue death) of the lunate bone
  • Scaphoid instability
  • Dislocated wrist bones

Preparation for Arthroscopic Partial Wrist Fusion

Prior to the surgery:

  • Your surgeon will examine your wrist and have you perform specific movements to assess the problem. The exact location and severity of the pain are essential in identifying the type and extent of the damage.
  • Your doctor will take your medical history and may order imaging tests such as X-ray, CT-scan or MRI. Certain blood tests may also be ordered.
  • Your doctor will discuss with you about the medicines you are taking and those you should stop taking prior to the procedure. Inform your doctor if you are allergic to any medicines or anesthesia.
  • Your doctor will advise you to stop smoking several days before the surgery as it negatively impacts healing.

Procedure of Arthroscopic Partial Wrist Fusion

The procedure is performed under general anesthesia and involves the following steps:

  • Your surgeon will make a few small incisions on the back of your wrist.
  • Arthroscopic portals (openings) are placed in specific locations on the wrist, depending on the areas that need to be fused.
  • An arthroscope is inserted into your wrist through one of the portals. The arthroscope is a thin tube with a camera, lens and light source. Your surgeon will be guided by the images relayed from the arthroscope onto a video monitor throughout the procedure.
  • Special surgical instruments are used to remove damaged bone or cartilage.
  • After aligning the bones, wires, staples, and screws are used to fix the damaged bones in position. Special implants may also be used.
  • Bone grafts (typically taken from the hip bone) are inserted and impacted to the fusion site.
  • The placement of an implant is confirmed under fluoroscopic control.
  • The incisions are closed with a bandage.

Immediately after the Surgery

You may have to stay at the hospital for a day or two. Your doctor will prescribe pain medications as needed.

Post-operative Care

Your wrist may be immobilized for up to 6 weeks. You will be instructed to perform specific physical therapy exercises as you heal.

Complications of Arthroscopic Partial Wrist Fusion

Complications are rare but can include:

  • Delayed fusion of bones
  • Failure to fuse, especially in smokers
  • Infection
  • Ulnar-side wrist pain
  • Arthritic changes

Advantages of Arthroscopic Partial Wrist Fusion

The advantages include:

  • Small incisions
  • Short recovery period
  • Improved joint function
  • Small surgical scars
  • Quick return to work and normal activities

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