Complex Wrist And Hand Fractures

Disease Overview

Your wrist is a complex joint made up of eight small bones called carpal bones. These bones are supported by connecting ligaments. Various conditions can affect your wrist joint such as carpal tunnel syndrome, osteoarthritis and others.

What is Wrist Arthroscopy?

Wrist arthroscopy is a minimally invasive surgical procedure performed to view, diagnose and treat problems of your wrist joint.

Indications of Wrist Arthroscopy

Wrist arthroscopy may be necessary to help in diagnosing:

• Stiffness
• Unexplained pain
• Swelling 
• Giving way or popping of the joint

Wrist arthroscopy is also used to treat conditions such as:

• Arthritis
• Chronic wrist pain
• Wrist fractures
• Ligament tears
• Ganglion cysts 
• Carpal tunnel syndrome 

Wrist Arthroscopy Procedure 

Wrist arthroscopy is usually performed under regional anesthesia. You may be given a sedative to keep you relaxed.

Your doctor will make one or two small half-inch incisions, known as portals, on the back of your wrist. The portals are placed in specific locations on the wrist, depending on the areas that need to be visualized. The arthroscope and special surgical instruments are inserted into your wrist through these portals. The arthroscope is a thin tube with a camera, lens and light source. Your doctor will be guided by the images relayed from the arthroscope onto a video monitor throughout your procedure. Your doctor will perform any necessary repairs depending on your problem. 

After the procedure, the portals are closed with small stitches and a dressing is applied. You may be instructed to wear a splint for a short time after the procedure.

Postoperative Care following Wrist Arthroscopy

Keep your hand elevated above the level of your heart for the first 2 to 3 days after your procedure. Keep your bandage clean, dry and intact. You may apply ice over the operated area to reduce swelling and discomfort. You will be instructed on special exercises to regain strength and mobility of your wrist. You will be prescribed pain medications to relieve any pain.

Advantages of Wrist Arthroscopy

Recovery following wrist arthroscopy is generally more comfortable than an open surgery, which requires a larger incision. There is usually less pain following the procedure and the healing time is faster when compared to an open procedure. Wrist arthroscopy is performed as a day surgery where most often you can go home within several hours after their surgery.

Risks and Complications of Wrist Arthroscopy

Complications are rare with wrist arthroscopy. However, some of the possible complications that can occur include scarring, bleeding, swelling, infection, numbness and injury to adjoining structures.

Elbow Anatomy

The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow to form the top of the hinge joint. The lower arm or forearm consists of two bones, the radius, and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

What is Arthritis?

Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain-free movement in the joint. This surface can wear out for several reasons. Often the definite cause is unknown.

When the articular cartilage wears out, the bone ends rub on one another, causing pain, swelling, stiffness, and interference with the use of the arm. In general, but not always, arthritis affects people as they get older. 

Treatment Options for Elbow Arthritis

Treatment can include conservative options such as medications and steroid injections to relieve pain, activity modification and use of splints, or surgery.

What is Total Elbow Replacement?

Elbow joint replacement, also referred to as total elbow arthroplasty, is an operative procedure to treat the symptoms of arthritis that have not responded to non-surgical treatments. The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint.

Indications for Total Elbow Replacement

Elbow joint replacement surgery may be recommended by your surgeon for the treatment of severe arthritis that has not responded to conservative treatment options.

Other indications for elbow joint replacement surgery may include:

• Severe elbow fracture in older patients with osteoporosis; a disease that causes bone loss and raises the risk of fractures
• Tumor or growth in the elbow joint
• History of previous elbow surgery
• Your overall health is good

Total Elbow Replacement Procedure 

The surgery is performed under sterile conditions in an operating room under general or regional anesthesia and involves the following steps:

• An incision is made over the back of the elbow.
• The muscles are retracted, and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.
• The damaged joint surfaces of the humerus, radius, and ulna are trimmed with a surgical saw to create a smooth surface for the attachment of the implants.
• A special instrument is used to hollow out the inside of the humerus bone to insert the humeral component of the prosthesis.
• Once a proper fit is established, your surgeon repeats this procedure on the ulna bone to prepare it for the ulnar component of the prosthesis.
• The humerus and ulna bones are then prepared with or without cement, depending on your surgeon’s preference.
• The components are then inserted and put together, ensuring proper movement of the hinge portion of the prosthesis.
• With all the new components in place, the joint is tested through its range of motion.
• Your surgeon then irrigates the new joint with sterile saline.
• The joint capsule is then sutured back together, the muscles and tendons are repaired and the skin sutures, usually with a drain in place to help any blood drain from the area.
• The elbow is then dressed and bandaged.

Postoperative Care for Total Elbow Replacement

After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed. The common postoperative guidelines include the following:

• You will probably stay in the hospital for 4-5 days after the surgery.
• Your pain will be managed with a PCA machine (patient-controlled analgesia), injections or pain pills. A PCA machine enables you to push a button to deliver a dose of pain medicine through IV.
• Your arm will be in a sling or splint with a bulky dressing.
• You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 days.
• Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.
• Occupational therapy (OT) will begin soon after surgery and continue for about 3 months to regain full range of motion of the elbow joint.
• Sutures will usually be removed after 10-14 days.
• Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.
• You will be given specific instructions regarding activity and rehabilitation.
• Eating a healthy diet and not smoking will promote healing.

Risks and Complications of Total Elbow Replacement

Most patients suffer no complications following elbow joint replacement; however, complications can occur following elbow surgery and may include:

• Infection
• Fractures of the humerus or ulna bone
• Dislocation of the elbow
• Damage to the nerves or blood vessels
• Blood clots (deep venous thrombosis)
• Loosening of artificial components
• Wound irritation
• Failure to relieve pain