Wrist reconstruction, replacement, or fusion

Wrist reconstruction

Wrist reconstructive surgery is performed primarily to restore lost functions and relieve pain in cases of trauma, developmental deformities, or arthritis. The procedures for complete wrist reconstructions are:

Anatomical reconstruction

  • Primary reconstruction of the injured joint (ligament repair or fracture reduction and internal fixation)
  • Correctional operations (osteotomies or ligament reconstruction)

Restoration of function without anatomical reconstruction

  • Partial or total arthroplasty, or joint replacement
  • Partial or total Arthrodesis, or fusion

Normal function can be best restored using anatomical reconstruction, but if it is not possible, other methods such as arthroplasty or arthrodesis are done to achieve functional repair and pain relief.

In cases of trauma to the wrist, reconstructive surgery involves repair of the injured structure if possible, or reconstruction of the injured structure using borrowed tissue from another part of the body, or sometimes from a cadaver.

In arthritic conditions of the wrist, a partial fusion or arthrodesis is performed to preserve joint function while reducing pain. At times, total wrist fusion is necessary for pain relief.

Wrist reconstructive surgery is also necessary to correct congenital deformities.

Extensive burns on the hand can lead to deeper tissue loss and exposure of tendons. In these cases, reconstruction is done using a tissue flaps from the upper arm or back to cover the lost tissues. Microvascular repair of the artery and veins is done to restore blood circulation to the transplanted graft area. These are procedures performed in specialty hospitals where resources are available for the complexity of the surgery and post-operative care of these injuries.


Wrist replacement

Wrist Replacement surgery, also called Total Wrist Arthroplasty, is used to treat the symptoms of arthritis that have not responded to non-surgical treatments such as medication, therapy, or splinting. Arthritis is a general term covering numerous conditions where the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain free movement in the joint. This surface can wear out for a number of reasons. Often the cause is unknown.

When the articular cartilage wears out, the bone ends rub on one another causing inflammation and pain. In general, but not always, arthritis affects people as they get older. This type of arthritis is called “wear and tear” arthritis or Osteoarthritis. Cartilage can also wear out due to inflammatory arthritis such as Rheumatoid Arthritis.

The goal of wrist joint replacement surgery is to eliminate pain and increase the functionality of the wrist joint. There are several restrictions following wrist replacement surgery, and therefore it is not a surgery for everyone. Dr. Yu will discuss the indications with you, and determine if this is a potential procedure for your wrist.

Wrist joint replacement surgery is performed under sterile conditions in the operating room under general or regional anesthesia. The surgery may be done as day surgery enabling you to go home the same day.


Wrist fusion

Joint fusion is a surgical procedure that involves removal of the damaged ends of a joint and fusing them together. Fusion eliminates movement of a joint. The primary goal of fusion, whether partial or total, is pain relief.

Arthritis of the finger and wrist results in the loss of the cushioning articular cartilage which results in pain and inflammation. Arthritic pain that does not respond to other forms of treatment is the usual indication for consideration of joint fusion.

There are several types of wrist fusion. The appropriate fusion for your wrist depends on the nature and location of the arthritis, your particular demands for your wrist, and the quality of your bone. You and Dr. Yu together will determine the options to help eliminate your pain, and if joint fusion is one of those options.

A Cast or a splint is usually required following joint fusion, in order to protect the bones as they attempt to fuse together. Swelling is typically observed after surgery which can be treated by elevation above the heart level for few weeks after surgery, along with icing and sometimes anti-inflammatroy medication.

Rehabilitation is generally suggested after the surgery which helps to control pain and swelling, and improve motion of the surrounding joints. Gentle massages and strengthening exercises will help to improve the grip strength and movement. This can be done on your own as instructed by your doctor, or under the supervision of a hand therapist.

  • American Society for Surgery of the Hand (ASSH)
  • American Academy of Orthopaedic Surgeons (AAOS)
  • The American Board of Orthopaedic Surgery (ABOS)