In cases where the ligaments are completely torn and the joints are no longer lined up, surgery may be suggested to either repair the ligaments or pin the bones together in the proper alignment to hold them in place while the ligaments heal.
There is no single operation that is used to fix ligament injuries of the wrist. Several surgical procedures are used depending on the problem.
Percutaneous Pinning and Repair of the Ligaments
If the ligament damage is recognized within a few weeks after the injury, the surgeon may be able to to hold the bones in place while the ligaments heal. This procedure is called a percutaneous pinning. (Percutaneous means through the skin; an incision is not required.) The surgeon uses a fluoroscope to watch as the pins are placed. The fluoroscope is a type of continuous X-ray machine that shows the X-ray image on a TV screen.
In some cases, getting the bones lined up properly is not possible, and an incision must be made to repair the ligaments. The longer the surgery is done after the initial injury, the less likely it is that the bones can be aligned properly. It is also less likely that torn ligaments will heal once scar tissue has developed over the ends. The metal pins are placed to hold the bones still while the ligaments heal. The pins are usually removed four to six weeks after the procedure.
Ligament Reconstruction
When the ligament damage is discovered six months or more after the initial injury, the ligament may need to be reconstructed. This procedure involves making an incision over the wrist joint and locating the torn ligament. Once this is done, a is used to replace the ligaments that have been torn. The tendon graft is usually borrowed from the palmaris longus tendon of the same wrist. This tendon doesn't do much and is commonly used as a tendon graft for surgical procedures around the hand and wrist. The tendon is removed from the underside of the wrist through one or two small incisions.
Again, metal pins are used to hold the bones stationary while the tendon graft heals. The pins are removed six to eight weeks after the surgery.
Fusion
When the ligament instability is discovered long after the injury and arthritis is present in the joints between the unstable bones, a fusion may be suggested. Two or more bones are fused by removing the cartilage surface between the bones. When the raw bone surfaces are placed together, the bone treats them as it would a fracture. The surfaces heal together. The bones fuse into one bone. This stabilizes the motion between the bones and reduces the pain that occurs when the arthritic joint surfaces rub together.
If the entire wrist has become arthritic from longstanding instability, a complete wrist fusion may be required.
Related Document: Collective Health's Guide to Wrist Fusion
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