During the October of 2015, two things came to my awareness that affected my (already compromised) wrist in significant ways. Firstly, the winter that had just passed, while milder than average, had afforded me serious grief in my wrist in a general sense. Secondly, the regular mountain biking I had been undertaking each weekend had been noticeably more painful during the 3 months prior. Because of these issues, and to get to the point; I decided at this time to opt for a full wrist fusion. Initially I planned for April 2016, but as riding was becoming so painful, there was no real point in delaying. I therefore brought the date forward to be asap, which turned out to be early December 2015.
I was due for surgery on the 5th December 2015, but my specialist wanted to see me the day prior. A current x-ray was requested for this day and it confirmed my aforementioned grief. The x-ray (see below) showed two things of note; (i) the scaphoid bone was of mixed quality and (ii) it was impinging directly on the radius. The constant contact between the bones with severe lack of protective cartilage (due to initial injury 19th May 2013) revealed a severe onset of arthritis at the joint. While nasty news, it at least confirmed the need for a full wrist fusion.
A full wrist fusion (wrist arthrodesis) is a tried and true method that minimises pain by fixing the bones at the joint which by definition arrests all motion at the wrist joint. Thankfully it was my left hand which is not my dominant hand. Doctors perform the wrist fusion in a variety of different ways. My specialist combined two techniques simultaneously:
- A proximal row carpectomy (PRC)
- Wrist fusion using a standard 9-screw plate with a 10 degree upright bend at the hand to the arm.
A PRC can actually be done it’s own right with no fusion. But the two combined methods have shown to be very successful. In a PRC, the scaphoid, lunate and triquetral bones which are based at the radius/ulna are removed, ground to a paste and used a graft/filler to complete the wrist fusion. This shortens the wrist by 1-2cm but importantly, does not require an ancillary bone graft (say from the hip) which can end up causing more grief than the original injury. Of course this will always be a personal choice, but my proximal bones were compromised anyway and it seemed a clever way to do it. As an aside I know a few friends with horror tales of bone grafts and I didn’t want to add to an already nasty injury in the interests keeping myself together; physically and psychologically.
Fast forward to the next day and I was loaded up with a lovely afternoon cocktail from the anaesthetist Daniel. The supposed 2 hour operation actually took 5 hours in reality. I awoke to a vague discussion with my specialist and got a “yes, it went well” and also a very tired and concerned girlfriend. I had been given a full arm block so I was not in pain for a good few hours after surgery and then it wore off…
When the pain was starting to get outrageous I started using the bedside ‘press-me-for-morphine’ joystick. Not sure why but it actually didn’t really help. I would give the pain an 8 (out of 10) on this first day. By way of contrast, 30 minutes after my initial crash in 2013, the pain was absolutely 10 (out of 10). The first three days were 8 out of 10 pain-wise and I took a cocktail of Endone, Panadeine Forte, Panadol Osteo and Neurofen. After the 4th day, my pain dropped to 7 and then 6 by the end of a full week and I restricted my drugs to Panadol Osteo and Neurofen.
The following three images show my hand after surgery, mid and end of week. The puffing reduced midweek, but the bruising increased.