Remaining Partial toward Wrist Fusion

Wrist injuries from trauma or work and sports activities may be serious enough to require partial wrist fusion. This procedure is used to reduce wrist pain while preserving wrist movement. Such a combination is especially vital to professional athletes who have a limited number of years to earn a high income.

A partial fusion uses bone graft from one of the bones in the forearm to join three small wrist bones together: the scaphoid, the trapezium, and the trapezoid. These three bones form a triangle on the thumb side of the wrist. The fusion holds these bones in place when pressure or load is put on the wrist. Without the fusion, the scaphoid is free to slip out from beneath the nearby capitate bone.

Problems can occur with this treatment method. One concern is that the fusion causes forces to pass to the nearby wrist bones, producing arthritis in the joints formed by these bones.

Hand surgeons in Connecticut tracked 800 cases of partial fusions over a 27-year period. Each patient was tested for motion, grip and pinch strength, pain, and return to work. The rate of arthritis and other complications was also measured.

The authors report a good result (no wrist pain and 70 percent or more motion) in up to 90 percent of patients. An equal number of patients was able to return to their previous jobs. Less than two percent of all patients developed arthritis. These results were better than reported from previous studies.

The authors conclude that they had better than usual results for several reasons. The doctors prepared the bony surfaces before grafting, and they used pins to hold the graft together during healing. Patients were immobilized for six weeks after surgery. According to the doctors in this study, good surgical technique reduces complications with this type of wrist surgery.