This handout explains the follow-up care after wrist fusion (arthrodesis) surgery. The wrist has been fused to eliminate pain at the arthritic joint, which will allow for improved function. In order to stabilize the wrist fusion, a metal plate has been used that spans the length from the forearm, or radius bone, to the hand, or metacarpal bone. You will have a drain in place to remove fluid from around the surgery site and to decrease the risk of infection. Please continue to take the antibiotics you were prescribed until the drain has been removed. We can schedule removal of the drain at the office 2 days after surgery or the nurses can instruct you on how to remove this at home, if you prefer. The splint is there for your protection. You may unwrap & rewrap the ace bandages if you feel that the splint is too tight.

If the skin around the incision is red or if there is drainage coming out of it, please call us right away. The phone number is at the bottom of the page. Go to the emergency room if this occurs at night or on a weekend. Please do not lift with the operable hand until instructed to do so after starting therapy. You will be scheduled to begin a therapy program the week after surgery so that we may make a more comfortable splint & new liner once your swelling has decreased.

Wound Care:

  • Metal screws and a plate are used to fuse the wrist.
  • Your arm will be placed in a bulky splint after surgery. This helps to protect the surgical site and lessen swelling. When bathing, put a plastic bag around your arm to keep the splint clean and dry.
  • Elevate your arm as much as possible each day to lessen the swelling and pain.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take the pain medication as it is prescribed, taking the right dose at the right time to best manage your pain. As it takes about 1 hour for the medication to take effect, it is important to “stay ahead” with your pain medication and avoid having to play “catch up” for a significant increase in pain.
  • Medication for nausea may also be provided. Please make sure to take this as directed, typically it is placed under the tongue (sublingual) to be absorbed in the mouth.
  • Please make sure to check with the postoperative nurse or the Bellevue Bone & Joint Physicians staff about how to manage your pain medication.
  • Please see the “Medications After Surgery” form for more instructions.
  • If you have uncomfortable side effects from the pain medication please call us.
  • It is normal to have some pain off and on for approximately one year after surgery, particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medication, as it is unsafe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.
  • Once you are no longer taking narcotic medication you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • You have decreased use of the operative arm for about six weeks after surgery until the tissue heals.
  • Do not lift anything heavier than a pencil or pen until your sutures have been removed and you have been advised to advance your activity by your physician or therapist.

Follow-Up:

  • If a drain is installed to prevent fluid from accumulating in the surgical site, it can be removed by BBJP hand therapy within 3 days following surgery. Oral antibiotics should be taken 4 times a day until the drain is removed.
  • The sutures will be removed beginning 10-14 days after surgery.
  • Your arm will be placed in a splint or cast depending on the level of protection needed.
  • A hand therapist will help to teach you exercises to lessen the scarring around the incision, improve range of motion of the fingers, and when appropriate increase your hand and arm strength.

Results:

Finger stiffness is common after wrist fusion surgery and decreases with use. Shooting electrical pains can occur that should decrease in frequency and intensity over time. Hypersensitivity at the surgical scar can be reduced by rubbing the skin using materials with different textures.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD