Total Wrist Fusion Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For long-standing wear-and-tear arthritis, we usually try activity changes, hand therapy, splinting, and injections first. We consider surgery when that has not given enough improvement.
Your surgeon may recommend total wrist fusion to join the wrist bones together. This creates a stable, pain-free joint. It is often offered for end-stage arthritis or when other treatments fail. The main benefit is reliable pain relief and improved hand function. While other options exist, fusion remains a standard choice for stability. We discuss this with you to ensure it matches your daily needs.
Before the operation
We will arrange preoperative investigations such as X-rays, MRI scans, and blood tests to check your wrist and overall health. If you have other medical conditions, you may need blood tests or a review with the anaesthetist before surgery. Please fast for the required time before your procedure. Stop taking any medications that affect bleeding, but only after your surgeon gives you specific instructions. Bring a complete list of your current medicines to hospital. Wear comfortable, loose-fitting clothing that is easy to remove. You must arrange for someone to drive you home and stay with you for the first 24 hours after surgery.
On the day
You present to the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist, who reviews your health and plans your comfort. 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.
You are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. They check your pain levels and ensure you are stable. Once you are stable you either go to the ward or go home, depending on the procedure and your recovery. Your surgeon will guide you on which path is right for you.
What the operation involves
Your surgeon makes a single cut along the back of your wrist. This open approach gives clear access to the joint surfaces that need treatment. Through this opening, your surgeon removes the worn-out cartilage and bone ends from the forearm and hand bones. This prepares the surfaces so they can heal together as one solid piece.
To hold your wrist in the correct position while it heals, your surgeon uses internal fixation. This typically involves metal plates and screws that are secured directly to the bone. These implants keep the bones stable and aligned. In some cases, additional techniques such as removing small bone fragments may be used to improve movement or stability, depending on your specific anatomy.
Once the bones are fixed in place, your surgeon closes the cut with stitches. A dressing is applied to protect the area. The entire procedure is performed under general anaesthesia, meaning you will be asleep and feel no pain during the operation. Afterward, your wrist will be placed in a cast or splint to keep it still while the initial healing begins.
After the operation
You will wake up in the recovery ward with your wrist supported in a splint or cast. We manage your pain using general methods and oral medication to keep you comfortable. A nurse will check your wound dressing regularly to ensure it stays clean and dry. You must have someone stay with you for the first 24 hours to help you at home. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must not drive while your wrist is immobilised. You can typically resume driving six to eight weeks after the cast or splint is removed and your surgeon clears you.
Recovery
In the first few days, you will likely feel soreness and swelling. This is normal. We use ultrasound-guided nerve blocks and oral pain relief to keep you comfortable without numbing your hand muscles. Keep your arm elevated to help the swelling go down. Rest is key right now.
You will wear a splint or cast to protect the fusion. Do not drive while your wrist is immobilised. You can drive once the cast or splint is removed and your surgeon clears you. See our guide on driving after upper-limb surgery for more details. At home, you will use your other hand for daily tasks. Avoid gripping or lifting heavy items.
As the swelling settles, your surgeon will guide you on starting gentle movements. Early motion helps you regain function faster with fewer therapy visits. Your rehabilitation is with Ruby Doolan at Extend Rehabilitation. She will teach you exercises to restore movement and strength. You will notice improvements in your grip and hand use as healing progresses.
Your timeline may differ; your surgeon and hand therapist will guide you.
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.
If you have a wrist joint replacement, you might notice signs that the implant is loosening or that bone loss is occurring. This can feel like increasing pain or instability in the wrist that does not settle with rest. If you experience this, contact our clinic so we can check the implant with an X-ray.
With a wrist fusion, the main concern is whether the bones heal together properly. If the bones do not fully fuse, you may feel persistent pain or a sense of movement where there should be none. You might also notice issues related to the screws or plates holding the bones in place. This could feel like hardware irritation or discomfort under the skin. If you notice these signs, please bring them up at your next review or call us sooner if the pain is severe.
If you are having a revision surgery to fix a previous joint replacement, be aware that these procedures carry their own risks. You might experience new pain or swelling as the surgeon works to salvage the joint. Similarly, if you are having a fusion to fix a failed replacement, there is a chance of complications during the healing process. Report any unusual pain, redness, or drainage from the wound immediately.
For patients with specific arthritis patterns, such as scapholunate advanced collapse, you might undergo a fusion that involves only part of the wrist. In some cases, the expected benefit of keeping the rest of the wrist moving may not happen. You might find that your wrist feels stiffer than anticipated or that pain persists despite the surgery. If your recovery does not feel like it is improving as expected, discuss this with us.
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 redness or discharge from your wound, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or cannot move your limb. These signs need urgent assessment. We want to ensure your recovery stays on track and address any concerns quickly.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Wrist Osteoarthritis page.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Wrist Osteoarthritis page.
