Wrist fusion (arthrodesis) is an operation to permanently stiffen the wrist joint by joining the radius to the carpal bones using a plate and screws. It eliminates painful wrist motion and provides a strong, pain-free wrist.
An incision is made on the back of the wrist. The cartilage is removed from the wrist joint surfaces. The bones are aligned in a functional position (slight extension) and fixed with a plate and screws. Bone graft is used to promote fusion. The operation takes one and a half to two hours.
Wrist fusion is recommended for severe wrist arthritis (post-traumatic, inflammatory, or degenerative), failed previous wrist surgery, wrist instability not amenable to reconstruction, and severe wrist deformity.
Wrist splinting, activity modification, corticosteroid injection, pain medication, and partial wrist fusions that preserve some motion (such as four-corner fusion).
X-rays and CT scan. Discussion of functional impact — loss of wrist flexion and extension.
Reliable pain relief and a strong, stable wrist. Grip strength is usually well preserved or improved. Forearm rotation (pronation/supination) is preserved.
Expected — the wrist no longer flexes or extends. Forearm rotation is preserved.
The plate on the back of the wrist may be palpable under thin skin.
Hand swelling for several weeks.
Failure to fuse. Risk approximately 5%.
Extensor tendons may rub on the plate, rarely causing rupture.
Sensory nerve branches on the back of the wrist.
Wound or deep infection.
May be needed if prominent or causing tendon irritation.
General or regional anaesthesia.
Cast or splint for six to eight weeks. Finger exercises begin immediately. Grip strengthening from six weeks. Return to manual work at three months. Full recovery three to six months.
X-rays at six weeks and three months to confirm fusion.
Most people adapt well. Forearm rotation is preserved, and many daily tasks are performed with the wrist in a neutral or slightly extended position anyway. Grip strength is usually maintained or improved.
Yes, procedures like four-corner fusion or scaphoid excision preserve some wrist motion. These are suitable for specific patterns of arthritis and will be discussed if appropriate.