From the Research
The post-operative protocol for a 4-corner wrist fusion typically involves immobilization in a short arm cast or splint for 6-8 weeks, followed by gradual progression to range of motion and strengthening exercises, with the goal of achieving optimal pain relief, grip strength, and functional outcome, as supported by the most recent study 1.
Key Components of Post-Operative Protocol
- Immobilization: 6-8 weeks in a short arm cast or splint to allow for proper bone healing and fusion
- Pain management: acetaminophen (500-1000mg every 6 hours) and NSAIDs like ibuprofen (400-600mg every 6-8 hours) as needed, with stronger opioid medications such as hydrocodone/acetaminophen prescribed for breakthrough pain in the first few days
- Elevation and ice application: to reduce swelling, with elevation of the hand above heart level and ice application for 20 minutes several times daily
- Range of motion exercises: gentle exercises focusing on finger mobility while protecting the wrist, starting after cast removal
- Physical therapy: starting around 8-12 weeks post-surgery, gradually progressing from passive to active wrist exercises
- Strengthening exercises: beginning around 12 weeks when fusion is radiographically confirmed
Expected Outcomes and Considerations
- Permanent reduction in wrist motion, particularly in flexion/extension, as this procedure sacrifices some mobility to eliminate pain from the damaged joints
- Full recovery and return to activities may take 4-6 months, though light activities can often resume around 3 months post-surgery
- Regular follow-up appointments with radiographs are essential to monitor fusion progress, as noted in studies such as 2 and 3
- The choice of fixation method, such as K-wires, locking plates, or headless retrograde compressive screws, may influence outcomes, with headless retrograde compressive screw fixation showing significant better results regarding pain relief and postoperative DASH-scores in one study 4