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The wrist joint
is one of the most complex joints

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in the human body.

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Numerous joints and bones

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contribute to the strength
and stability of the wrist.

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The wrist is made up of

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eight separate small bones
called carpal bones.

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The carpal bones
connect the two bones of the forearm,

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the radius and the ulna,

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to the bones of the hand.

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The metacarpal bones
are the long bones that lie within the palm

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that attach to the phalanges,
the bones in the fingers and thumb.

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Articular cartilage is the white tissue
lining the ends of bones

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where the bones connect
to form joints.

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Cartilage acts
as cushioning material

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and helps in smooth gliding
of bones during movement.

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An injury to the joint
may damage this cartilage,

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causing severe pain
and inflammation,

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known as degenerative arthritis.

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Arthrodesis is
the surgical immobilization of a joint

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by the fusion of the adjacent bones.

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Total wrist arthrodesis,
also known as wrist fusion,

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is a surgical procedure,

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in which the wrist joint
is stabilized or immobilized

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by fusing the forearm bone
(radius)

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with the small bones of the wrist.

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Arthrodesis is done
to relieve the pain

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after severe trauma to the wrist.

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A painful wrist causes disability

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and affects function
of the upper extremity.

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Indications.

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Total wrist arthrodesis
may be recommended by your doctor

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when conservative treatments

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such as rest, medications,
injections and physical therapy

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do not relieve the pain.

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Indications for the surgery include:

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Advanced symptomatic arthritis

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secondary to a degenerative, post-traumatic,

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inflammatory or post-infectious condition.

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Wrist trauma and instability.

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Joint destruction due to tumors.

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Correction of wrist deformities

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in patients
with spastic hemiplegia.

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Unsuccessful wrist reconstruction

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or arthroplasty
with or without joint replacement.

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Evaluation and diagnosis.

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Your orthopedic surgeon
will gather your medical history

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and perform a physical examination
of the wrist.

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Diagnostic studies
will be carried out and may include

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X-rays,
to investigate bony structures of the joint,

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MRI scan, to generate images
of both bone and soft tissues,

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CT (Computed tomography) scan,

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to evaluate the wrist bones
in detail,

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which is difficult to view
on a plain radiograph.

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Surgery.

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Various techniques are in practice

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for achieving
a successful arthrodesis.

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The type of operative technique

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depends on the underlying condition,
quality of bone,

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condition of the remaining joints
of the involved extremity

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and the surgeon's preference.

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Procedure.

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Total wrist arthrodesis
is usually performed

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under general anesthesia.

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Your surgeon makes an incision
on the back of the wrist.

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This type of incision
decreases the chances of damage

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to the blood vessels and nerves.

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The soft tissues are retracted

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to gain access to the bones
and joints of the wrist.

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Any articular cartilage present

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is removed from each joint
to be fused

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and a bone graft
(derived from the end of the radius bone)

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is used
to replace the lost cartilage.

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A metal plate
with screw holes

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is placed
over the back of the wrist.

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The plate extends from the radius

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to the metacarpal bone
of the middle finger

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and is attached to the bone
with metal screws.

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The plate holds the bones
in the proper position

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and ensures they stay together
during the healing process.

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The plate remains in the body

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and is not removed
unless it is causing problems.

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At the end of the procedure,
the incisions are closed with sutures.

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Postoperative care.

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The postsurgical instructions
to follow

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depend on
the type of repair performed.

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Some of the instructions include:

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Take medications as prescribed
by your doctor

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to help alleviate pain
and make you comfortable.

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Keep your arm elevated on pillows
above the level of the heart.

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It is the most important thing you can do
to reduce swelling.

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Keep the incision area
clean and dry.

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If the wrist is enclosed by a cast,

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cover the cast with plastic bags

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and tape to your skin
above the cast

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to keep it dry when bathing.

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Follow the suggested instructions

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regarding activity
and rehabilitation.

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Physical therapy will be ordered

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to help restore wrist function, strength
and range of motion.

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Eating a healthy diet and not smoking
promotes healing.

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Risks and complications.

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As with any major surgery,
there are potential risks involved

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with total wrist arthrodesis.

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Complications can occur

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following total wrist arthrodesis
and include:

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infection, excess bleeding,

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damage to blood vessels,
nerve injury,

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problems with instrumentation,
failure of bone fusion (non-union).

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Wrist arthrodesis is a surgical procedure
to relieve wrist pain

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that does not respond
to conservative treatment measures

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and continues to affect
a patient's quality of life.

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It results in a high degree
of patient satisfaction

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with respect to pain relief
as well as correction of deformity.