Total Wrist Fusion Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. Total wrist fusion joins your wrist bones together to stop painful movement. We typically offer this when wear-and-tear arthritis or injury has destroyed the joint surface. You usually reach our clinic via a GP or physiotherapist referral. We start with non-operative care like therapy or injections. Surgery follows only when these have not given enough improvement.
This procedure is common because it reliably stops pain and stabilises a damaged wrist. It is often the standard choice for severe rheumatoid arthritis or when other options have failed. While it limits wrist bending, it protects your hand function. We discuss this as a shared decision to help you manage pain and regain stability in your daily life.
Before the operation
Your surgeon will arrange X-rays, blood tests, and possibly an MRI to check your bones and soft tissues. These scans show the exact state of your wrist before surgery. You must fast from midnight the night before your procedure. Stop taking blood-thinning medications only after your surgeon gives you specific instructions. Bring a complete list of all medicines you take. Wear loose, comfortable clothing to your appointment. Please arrange for someone to drive you home after the operation, as you will not be able to drive yourself. We will review your anaesthetic plan with you to ensure you are safe and comfortable throughout the process.
On the day
You will arrive at the hospital for admission. Your surgeon will meet you to confirm the plan. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.
We perform this surgery using an open approach. This means we make a single conventional incision over the operative site. We do not use scopes or alternative incisions. Once the procedure is complete, you will wake up in our recovery area. Our team will monitor your comfort and stability as you begin to recover from the anaesthetic.
What the operation involves
Total wrist fusion is a procedure where your surgeon joins the bones of your wrist together so they grow into one solid piece. This stops the painful grinding of worn-out joint surfaces. We perform this operation through a single cut on the front of your wrist. This open approach gives your surgeon clear access to the area that needs treatment.
Inside the wrist, your surgeon removes the damaged cartilage from the ends of the bones. You can think of this like smoothing down rough edges so they can finally meet and heal together. Your surgeon then holds these bones in the correct position using small metal screws or plates. These implants act like an internal cast, keeping everything steady while your body heals the connection.
Once the bones are secured, your surgeon closes the cut with stitches or staples. A bandage is applied to protect the area. This surgery is typically used when other treatments have not worked, or in specific cases like severe rheumatoid arthritis where stability is the main goal. By fusing the joint, we aim to remove the source of pain completely, even though it means your wrist will no longer bend.
After the operation
You will wake up in the recovery ward with your arm in a sling and a protective dressing. Your surgeon will manage your pain using standard methods to keep you comfortable. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours to help you at home. We keep your arm still to protect the healing bones. Do not drive while your wrist is in the splint. Wrist fusion requires about six weeks in a splint before driving. NO DRIVING while immobilised. You can resume driving once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery.
Recovery
You will have a single incision over your wrist. In the first few days, swelling and stiffness are normal. We manage this with elevation and prescribed pain relief. Your wrist will be in a splint for about six weeks to protect the fusion while the bones join; a cast is not used.
Early movement of your fingers and forearm is important. We encourage you to start these gentle exercises soon after surgery. This helps you regain function faster and may reduce the number of therapy visits needed. Your hand therapy is provided by Ruby Doolan at Extend Rehabilitation. She will guide you through safe movements that do not stress the healing wrist.
Daily life changes while your wrist is immobilised. You cannot drive while in the splint. You must wait until it is removed and your surgeon clears you to drive. See our guide on driving after upper-limb surgery for more details. At home, you will adapt to one-handed tasks. Sleep with your arm supported on pillows to keep swelling down.
As the splint is removed, your wrist will feel stiff. This is expected. Your surgeon and physiotherapist will guide your next steps. Your timeline may differ from others. We focus on your comfort and steady progress rather than a fixed schedule.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Incomplete bone fusion is a common concern with wrist fusion. This means the bones do not join together as planned. You might notice persistent pain or a feeling of instability in your wrist that does not improve over time. If you feel your wrist is still moving when it should be still, or if pain lingers, please contact our clinic. We will review your progress and decide if further treatment is needed.
Hardware-related problems can also occur. This involves the screws, plates, or wires used to hold your bones in place. You might feel a sharp pain or notice a clicking sensation under the skin where the metal sits. Sometimes the hardware can become loose or irritate the surrounding tissue. If you feel something shifting or notice new tenderness over the metal, let us know. We can check if the hardware needs adjustment or removal.
If you have had previous wrist replacement surgery, fusion may be used as a salvage option. This means fixing a problem with an earlier operation. These revision procedures carry their own risks. You might experience increased pain, swelling, or difficulty moving the wrist compared to your baseline. If your symptoms worsen after this type of surgery, contact our team immediately. We need to ensure the revision is healing correctly and address any new issues promptly.
The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your limb. We want to catch any issues early so we can keep you safe and comfortable during your recovery.
