Proximal row carpectomy vs
Partial wrist fusion vs
Total wrist fusion vs
Total wrist replacement
This article is designed to give a simple over view of the options available.
These procedures are designed for patients that have failed conservative measures including rest, splints and injections. They are performed for severe pain and discomfort often the result of osteoarthritis.In such situations the first question we need to ask is whether patient requires wrist flexion and extension or are they happy to have a wrist fused abolishing this movement.Initial impressions are the most patients do not want a total wrist fusion and an inability to flex and extend the wrist.
However, after careful consideration and often speaking to other patients who have had the procedure, or discussions with a hand therapist, they realise that there are very few activities they will be unable to perform.The upper limb can accommodate a wrist fusion and get the hand into mots places providing there is a supply elbow and shoulder.
Wrist flexion and extension are required by some professions and these would include plastering, plumbing and being an electrician.
The majority of other activities of daily living activities are well accommodated with a total wrist fusion.If, after the above discussions, the patient is still adamant they wish to have flexion and extension at the wrist maintained the options are a proximal row carpectomy, a partial wrist fusion or total wrist replacement.
A total wrist fusion involves fusing all the bones in the wrist and preventing any flexion and extension. Rotation is however still preserved. Of all the operations this seems to be the most reliable to offer pain relief and a sold wrist with long term permanent results. The wrist is usually fixed in place with a plate on the back of the hand and wrist which has been pre bent with a bit of extension to allow a solid grip.
A proximal row carpectomy involves removing the scaphoid, lunate and triquetrum bones. The capitate bone then moves down and articulates with the lunate facet of the distal radius. This gives a more ball and start socket type joint. The advantages of this particular procedure is that there is no metalwork inserted into the joint, there is no risk of non-union and early mobilisation after 2 to 4 weeks.
A partial wrist fusion usually involves removing one of the arthritic bones and then stabilising the surrounding buildings by fusing them together. The most common scenario is removing the scaphoid bone and performing a four corner fusion of the lunate, capitate, triquetrum and hamate bones. The fusion site needs fixing with a variety of techniques including staples, plates or screws. Post-operatively the wrist is immobilised for 4 to 6 weeks to allow the bones to heal together. Risks associated with this procedure are non-union and metalwork problems and on occasions ulna sided wrist pain.
A total wrist replacement removes all the articulating surfaces and replaces them with an artificial joint. Two main types of joint replacements are available a classic ball and socket type joint or a pyrocarbon spacer. Post-operatively the patients are mobilised within the first two weeks. Risk associated with this procedure are stiffness and dislocation.