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Fusión de la muñeca

Un plan de recuperación tras la fusión total de la muñeca (artrodesis), en el cual la muñeca dañada se une de forma sólida mediante una placa dorsal para que, por diseño, ya no pueda moverse; mientras que los dedos, el pulgar y la rotación del antebrazo permanecen móviles desde el inicio, y la fuerza de agarre se va recuperando una vez que el hueso se haya consolidado.

Ilustración de una fusión total de la muñeca, fijada mediante una placa que se extiende desde el hueso del antebrazo hasta la mano.
Fusión total de la muñeca: una placa mantiene los huesos de la muñeca firmemente unidos mientras se fusionan en una sola unidad ósea. Esto elimina el doloroso movimiento artrítico, aunque a costa de perder la capacidad de flexión de la muñeca; en cambio, la rotación del antebrazo —esencial para la mayoría de las actividades diarias— se mantiene intacta. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Este protocolo le servirá de guía para su recuperación tras una fusión total de la muñeca (también denominada artrodesis de muñeca; es una intervención quirúrgica que une de forma permanente los huesos de la muñeca dañados, impidiendo así cualquier movimiento). El procedimiento fue realizado por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. El protocolo comienza con un programa de ejercicios para realizar en casa; posteriormente, sigue un plan clínico estructurado redactado para su terapeuta de mano: lleve esta página o su versión en PDF a su primera sesión de terapia, para que su rehabilitación se lleve a cabo de manera coordinada. Su terapeuta podrá modificar el plan según el progreso de su recuperación.

Si tiene alguna duda o inquietud respecto a la herida quirúrgica, no dude en ponerse en contacto con nuestra consulta. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su evaluación.

Qué esperar

La fusión total de la muñeca se realiza cuando todas las articulaciones de la muñeca están muy desgastadas (artritis en fase terminal o “pancarpal”) y causan dolor al moverse. En lugar de intentar mantener en movimiento una articulación deteriorada, la operación elimina deliberadamente el movimiento: el hueso del antebrazo (el radio) se une a los huesos de la mano (los metacarpianos) mediante una placa dorsal situada en la parte posterior de la muñeca, fijando así la muñeca en una posición de ligera inclinación hacia atrás (ligera extensión) óptima para agarrar. En las semanas siguientes, los huesos se unen formando un bloque sólido.

El concepto clave de esta recuperación es lo opuesto a la mayoría de las operaciones: la muñeca debe dejar de moverse; eso es la cura, no una complicación. Por lo tanto, no se busca recuperar el movimiento de la muñeca ni se realizan ejercicios para doblarla o estirarla. En cambio, toda la rehabilitación se centra en proteger dos aspectos que la fusión no afecta y que son fundamentales para la función de la mano:

  • Los dedos y el pulgar deben permanecer totalmente móviles. La rigidez de los dedos es el principal factor que puede hacer fracasar una fusión de muñeca; por eso el movimiento de dedos y pulgar se fomenta desde el primer día.
  • Se preserva la rotación del antebrazo (girar la palma hacia arriba y hacia abajo). Esta movilidad no se ve afectada por la fusión, y además asume gran parte de las funciones que antes realizaba la muñeca (girar llaves, grifos y manijas), por lo que se mantiene flexible desde el inicio.

Gracias a que la placa dorsal fija los huesos firmemente, se lleva una férula durante unas seis semanas mientras los huesos se unen; en este periodo se fomenta el movimiento temprano de dedos y antebrazo en lugar de restringirlo. Una vez que el cirujano confirma la consolidación ósea, se inicia el fortalecimiento de la prensión. Muchas personas logran una función muy buena tras una fusión de muñeca; al dejar de sentir dolor al agarrar, la fuerza de prensión suele mejorar en comparación con el estado previo a la cirugía.

Precauciones y limitaciones

  • NO intente mover la muñeca en sí: está fijada de forma permanente por diseño. No existen ejercicios para flexionar la muñeca, ni ahora ni nunca.
  • Asegúrese de mover los dedos, el pulgar y la rotación del antebrazo por completo desde el primer día: esto es lo más importante que puede hacer por su mano.
  • Use la férula o el vendaje según las indicaciones para mayor comodidad y protección, hasta que el hueso se haya consolidado; manténgalo limpio y seco.
  • NO ejerza carga ni apriete objetos con fuerza, y evite levantar algo más pesado que una taza ligera, hasta que la fusión ósea se haya completado y se le dé el visto bueno (normalmente entre seis y ocho semanas): aplicar carga excesiva antes de la consolidación puede provocar el fallo de la placa o de la fusión.
  • NO conduzca mientras lleve la férula o no pueda controlar el vehículo de forma segura; podrá volver a conducir una vez que se retire la férula y pueda manejar el volante, según lo confirmado en su revisión médica.

Para el cuidado de la herida, la hinchazón y las cicatrices, consulte las pautas de cuidado de heridas de nuestra clínica.

Sus ejercicios

Estos son los ejercicios que aparecen en su folleto. Comience a realizarlos únicamente bajo la guía del Dr. Hirpara y de su terapeuta de mano. Los ejercicios iniciales tienen como objetivo proteger lo que la fusión deja libre (el movimiento de dedos y pulgar, la rotación del antebrazo y el control de la hinchazón); ninguno de ellos implica la muñeca, que permanece inmóvil. El fortalecimiento de la prensión corresponde a una fase posterior y no debe iniciarse hasta que la fusión se haya consolidado y usted cuente con autorización expresa. Interrumpa cualquier ejercicio que le provoque dolor intenso en la parte dorsal de la muñeca.

Su protocolo clínico

El resto de esta página describe el protocolo clínico por fases para la rehabilitación tras una artrodesis total de la muñeca. Esta sección debe entregarse a su terapeuta de mano; cada fase comienza con una explicación sencilla en lenguaje coloquial de lo que se está realizando. No existe ningún objetivo de amplitud de movimiento de la muñeca: las articulaciones radiocarpiana (y habitualmente la tercera articulación carpometacarpiana) se fusionan mediante una placa dorsal. El protocolo tiene como finalidad preservar la amplitud de movimiento de los dedos, la rotación del antebrazo y controlar el edema mientras se produce la fusión; posteriormente, se trabaja para desarrollar la fuerza de agarre sobre la estructura ya estabilizada.

Antes de iniciar el tratamiento, revise el informe quirúrgico del paciente y su historial médico previo; además, consulte con el cirujano tratante respecto a la técnica empleada (placa dorsal para artrodesis; si se incluye o se preserva la tercera articulación CMC), la posición final de la muñeca tras la fusión, cualquier injerto óseo utilizado y el estado de consolidación ósea. El Dr. Hirpara realiza la fusión de la muñeca en ligera extensión mediante una placa dorsal; la fijación resulta estable, por lo que se emplea un cabestrillo ligero o vendaje para mayor comodidad en lugar de un molde rígido prolongado; la prioridad es iniciar cuanto antes el movimiento de los dedos y del antebrazo.

Fase I: proteger la estructura quirúrgica y mantener la movilidad de las articulaciones libres (semanas 0 a 6)

Durante las primeras seis semanas, se protege la fusión ósea en proceso de curación, mientras se mantiene totalmente móvil todo lo que no está fusionado. Se utiliza una férula ligera o vendaje para mayor comodidad. No se permite ningún movimiento de la muñeca (la estructura quirúrgica es rígida por diseño); el enfoque se centra exclusivamente en los dedos, el pulgar, el antebrazo y el control del edema.

Para su terapeuta de mano:

Educación y precauciones - Utilizar férula/vendaje para confort y protección hasta confirmar la unión clínica y radiográfica; no es necesario un moldeado rígido prolongado dado que la fijación con placa es estable. - Prohibido mover la muñeca: la estructura radiocarpiana y CMC está fusionada; no existe objetivo de amplitud de movimiento. - No realizar agarres con carga ni levantar objetos más pesados que una presión ligera hasta confirmar la unión ósea. - Vigilar la rigidez digital: este es el principal riesgo para el resultado post-fusión de muñeca.

Manejo - Herida: aplicar vendajes quirúrgicos según indicaciones; retirar puntos de sutura y revisar con férula/radiografía alrededor del día 10–14; monitorizar posibles infecciones. - Edema: mantener la mano elevada por encima del nivel del corazón, realizar movimientos de bombeo digital suaves y aplicar hielo según sea necesario. - Ejercicios: realizar movimientos activos de amplitud de movimiento en dedos y pulgar desde el primer día (formar un puño y volver a la extensión completa, oposición del pulgar); también movimientos activos de pronación/supinación del antebrazo; movilidad activa de hombro y codo. Queda prohibido cualquier movimiento de la muñeca y cualquier agarre con resistencia.

Criterios para avanzar a la siguiente fase - La herida está curada; se mantiene una amplitud de movimiento digital completa o casi completa; se observan signos radiográficos tempranos de unión ósea alrededor de la semana seis.

Fase II — confirmar la consolidación, iniciar la carga de agarre (semanas 6 a 12)

A partir de aproximadamente la sexta semana, la consolidación suele observarse en las radiografías; una vez que el cirujano lo confirma, se retira el yeso y se inicia el fortalecimiento del agarre. Se continúa con los ejercicios para el antebrazo y los dedos; la muñeca permanece inmovilizada y sin carga hasta que se confirme la consolidación.

Para su terapeuta de mano:

Evaluaciones - Confirmar el estado de consolidación con el cirujano tratante antes de iniciar la carga; evaluar el rango de movimiento digital; el arco de rotación del antebrazo; el nivel basal de agarre; revisar la herida y la cicatriz.

Educación y precauciones - Iniciar el agarre y la carga ligera solo después de que el cirujano confirme la consolidación (generalmente entre seis y ocho semanas). - Los implantes situados en la cara dorsal de la muñeca se encuentran por debajo de la piel; vigile cualquier protuberancia o irritación y repórtela. - Continúe priorizando el mantenimiento de un rango de movimiento digital completo.

Manejo - Ejercicios: fortalecimiento progresivo del agarre (desde una pelota blanda hasta plastilina y pinzas graduadas) una vez confirmada la consolidación; iniciar el manejo de la cicatriz una vez curada la herida; continuar con la rotación del antebrazo y el rango de movimiento digital completo; introducir un uso funcional ligero de la mano. - Explíquele al paciente que la rotación del antebrazo ahora sustituye al movimiento perdido de la muñeca en las actividades diarias (abrir llaves, teclear, girar objetos).

Criterios para avanzar - Consolidación confirmada; agarre ligero sin dolor; rango de movimiento digital completo; cicatriz móvil.

Fase III: Fortalecimiento y retorno a la carga (semanas 12 en adelante)

Una vez que la fusión ósea es sólida, ya no existen restricciones de movimiento que proteger; la mano puede soportar carga según la tolerancia del paciente y se puede ir aumentando progresivamente. La fuerza de prensión y la fuerza general de la mano siguen mejorando durante varios meses, a menudo superando los niveles previos a la cirugía, ya que la prensión ahora se realiza sin dolor.

Para su terapeuta de mano:

Evaluaciones - Fuerza de prensión comparada con el lado contralateral; pruebas funcionales y específicas para el trabajo o tareas; tolerancia al uso del material ortopédico

Educación y precauciones - No hay restricciones de movimiento una vez lograda la unión ósea; aumente la carga según la tolerancia del paciente - La carga pesada o manual debe incrementarse de forma gradual; la mejora de la fuerza total continúa hasta aproximadamente los doce meses

Manejo - Ejercicios: fortalecimiento progresivo de la prensión y del antebrazo mediante resistencia; retorno gradual a tareas funcionales y laborales; continuar con ejercicios para mantener la movilidad digital residual - Considere dar el alta cuando la fuerza de prensión sea funcional y siga mejorando, y el paciente pueda realizar sus tareas diarias; remítalo nuevamente al médico tratante si aparece rigidez digital, irritación persistente por el material ortopédico o un resultado insatisfactorio

Criterios para retornar a la carga - Unión ósea sólida; fuerza de prensión funcional y en mejora; capacidad de realizar tareas específicas sin dolor

Retorno al trabajo y a las actividades cotidianas

Se recomienda realizar desde el principio usos ligeros de la mano en la vida diaria (comer, escribir, cuidados personales básicos), siempre dentro de los límites de la comodidad, siempre y cuando no se ejerza una presión excesiva ni se levanten objetos más pesados que una taza ligera antes de que la fusión ósea se haya consolidado. Dado que no se debe conducir mientras se lleva la férula o cuando no se puede controlar el vehículo de forma segura, es necesario organizar ayuda para el transporte durante las primeras semanas; la conducción se reanuda una vez retirada la férula y se demuestre capacidad para manejar el volante, según lo confirmado en la consulta de seguimiento.

Los agarres con fuerza, levantamientos y tirones deben esperar hasta que la fusión ósea se haya consolidado (generalmente alrededor de seis a ocho semanas) y se cuente con autorización médica; posteriormente, se irán introduciendo gradualmente. La mayoría de las personas vuelven a su trabajo de oficina o a labores ligeras al cabo de unos tres meses; el retorno a trabajos más pesados o manuales se produce más tarde, siguiendo una progresión basada en criterios evaluados por el Dr. Hirpara y el terapeuta de mano, y no únicamente en el calendario. La fuerza de la mano sigue mejorando durante un año aproximadamente; y como la muñeca ya no duele, muchas personas logran agarrar con más fuerza y utilizar la mano con mayor libertad que antes de la cirugía.

Después de seguir este protocolo

Este protocolo complementa las recomendaciones generales de recuperación de la consulta: consulte control del dolor postoperatorio, cuidado de la herida y manejo de las cicatrices. El plan por fases descrito anteriormente se basa en resultados publicados y en pautas de rehabilitación tras una artrodesis total de la muñeca; su recuperación continua será guiada individualmente por el Dr. Hirpara y su terapeuta de mano, según el progreso de la fusión ósea y de su mano.


Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Total Wrist Arthrodesis — Procedure Outcomes & Post-operative Rehabilitation (Radiocarpal Fusion, Dorsal Plate)

Topic scope: post-operative rehabilitation after total wrist arthrodesis — permanent surgical fusion of the radiocarpal (and usually the third carpometacarpal) joints with a dorsal arthrodesis plate, for end-stage pancarpal (panarticular) arthritis of the wrist. This is a salvage reconstruction that deliberately abolishes wrist motion, not a motion-preserving operation, so the rehabilitation has no wrist-ROM goal. It is built around preserving the joints the fusion leaves free — the fingers, thumb and forearm rotation — and controlling oedema while the fusion unites, then progressive grip loading once united.

Defining principle of the rehab here: total wrist fusion trades motion for a stable, pain-free wrist. The whole wrist is set solid (radius → metacarpals) in slight extension; loss of wrist movement is the intended endpoint, not a deficit to be rehabilitated. Modern dorsal locking-plate fixation is rigid enough that prolonged casting is unnecessary — so the deliberate priorities are early digital and forearm-rotation motion (digital stiffness is the principal threat to a good result) and swelling control, with grip strengthening deferred until radiographic union (typically 6–8 weeks). The single branch point is union status: loading is gated on the surgeon confirming the fusion has consolidated, after which there are no motion restrictions to protect.


A. PROCEDURE OUTCOMES (total wrist arthrodesis, dorsal plate)

Total wrist arthrodesis is a reliable, durable salvage for the painful, arthritic wrist that has failed non-operative care: the great majority of patients obtain lasting pain relief and a stable hand, accepting the loss of wrist motion in exchange.

  • High union rates and durable pain relief. Plate arthrodesis is a well-established, reproducible operation; published series and the JAAOS review of indications and outcomes report reliable fusion, good pain relief and high patient satisfaction, with most patients willing to undergo it again [Wei & Feldon, JAAOS 2017; Shah et al., J Hand Surg Am 2022 — technique/modifications]. Moderate–strong (review + technique series).
  • Grip strength is preserved or improves. Because gripping is no longer painful and the wrist is a stable platform, grip strength after fusion is typically equal to or better than the painful pre-operative wrist. A 2026 systematic review and meta-analysis of long-term grip strength after total wrist fusion (comparing inclusion vs sparing of the third CMC joint) confirms maintained long-term grip with comparable complication profiles between the two constructs [Lawson-Smith et al., J Hand Surg Glob Online 2026]. Moderate (SR/meta-analysis).
  • Function is good for daily tasks; forearm rotation compensates for lost wrist motion. Patients adapt well because forearm pronation/supination (unaffected by the fusion) substitutes for much of the lost wrist arc in activities such as turning keys, taps and handles. Carpometacarpal-joint– sparing plate designs aim to retain a small amount of motion and reduce distal hardware issues [Briotti et al., HAND 2022 — Medartis CMC-sparing plate]. Moderate (cohort).
  • Complications are defined and manageable. Principal complications are nonunion, hardware prominence/irritation requiring plate removal (the dorsal plate is subcutaneous), wound issues, and adjacent-segment problems (distal radioulnar joint / digital stiffness). These are recognised, generally treatable, and informed-consent staples rather than common catastrophes [Wei & Feldon, JAAOS 2017; Kalb & Prommersberger, Oper Orthop Traumatol 2009 — AO plate technique]. Moderate.

B. REHABILITATION / THERAPY EVIDENCE

The rehab questions after total wrist fusion are different from a motion-preserving operation: there is no wrist arc to recover. The evidence and consensus instead converge on early mobilisation of the unfused joints, oedema control, and union-gated grip loading, exploiting the stability of modern plate fixation.

  • Stable plate fixation permits early digital and forearm motion. Rigid dorsal locking-plate constructs are robust enough that prolonged rigid immobilisation is unnecessary; a light splint or dressing for comfort, with immediate finger, thumb and forearm-rotation motion, is the intended default [Shah et al., J Hand Surg Am 2022; Kalb & Prommersberger, Oper Orthop Traumatol 2009]. Moderate (technique consensus).
  • Preserving digital range is the priority — stiffness is the main avoidable failure. Because the hand's function after fusion depends entirely on the joints left mobile, full active finger and thumb range from day one, plus preserved forearm rotation, is the core therapeutic aim. This is a mechanistic/consensus position rather than one from comparative rehab trials. Weak–moderate (mechanism strong, dedicated rehab RCTs absent).
  • Grip strengthening is deferred to union, then progressed freely. Loaded grip is withheld until the surgeon confirms radiographic union (commonly 6–8 weeks), after which there are no motion restrictions and strengthening is progressed as tolerated; grip continues to improve for several months. Consensus / protocol-based.
  • Hand therapy targets the free joints, not the wrist. Published patient-guidance protocols and surgical references describe early referral to a hand therapist for finger and forearm mobility and later putty-based grip strengthening — there is no wrist-ROM component by design [AAOS OrthoInfo — Wrist Fusion; institutional post-op protocols]. Consensus (patient-guidance).

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Protect construct, mobilise free joints Week 0–6 Light splint/dressing for comfort; no wrist motion (fused) Elevate; immediate full finger + thumb AROM; forearm pronation/supination; elbow/shoulder ROM; oedema control Light functional use only; no loaded grip / lifting > a light cup Sutures + splint/X-ray review ~10–14 days. Digital stiffness is the chief threat
II — Confirm union, begin grip loading Week 6–12 Loading gated on surgeon-confirmed union (≈6–8 wk) Splint discarded at union; progressive grip (ball → putty → grippers); scar massage once healed; continue forearm + digital ROM Grip introduced light → graded after union Forearm rotation substitutes for lost wrist motion. Watch dorsal hardware prominence
III — Strengthening & return to load Week 12 → 12 months None once united Progressive resisted grip/forearm strengthening; work-/task-specific loading Full load as tolerated; heavy/manual built up gradually Office/light work ~3 months; strength improves up to ~12 months, often exceeding pre-op (pain-free grip)

(Phase windows mirror the precautions and recovery structure in the patient protocol; they are typical guides anchored to union, not trial-derived deadlines.)


C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Fusion vs total wrist arthroplasty. The central modern controversy. Systematic review of total wrist arthroplasty versus arthrodesis (originally in rheumatoid disease) found insufficient evidence to declare either superior, with arthroplasty preserving some motion at the cost of higher revision/implant-related complications, and fusion offering durability at the cost of motion [Cavaliere & Chung, Plast Reconstr Surg 2008]. A cost-utility analysis found arthrodesis and arthroplasty both reasonable, with trade-offs in motion, complications and cost [Cavaliere & Chung, J Hand Surg Am 2010]. The "where are we now" synthesis frames the choice as patient-specific (demand, bilateral disease, expectations) rather than a settled winner [Jump, Trail & Talwalkar, J Hand Surg Eur 2025]. Moderate; genuine equipoise.
  2. Arthrodesis as salvage for failed arthroplasty. Total wrist fusion reliably salvages a failed total wrist arthroplasty, though such salvage fusions behave somewhat differently (bone loss, grafting) from primary arthrodesis [Zijlker et al., J Hand Surg Eur 2021]. Moderate.
  3. Include or spare the third CMC joint. Constructs differ in whether the plate crosses the third carpometacarpal joint. Long-term grip and complication outcomes are broadly comparable between inclusion and sparing, with CMC-sparing designs aiming to reduce distal hardware issues and retain a trace of motion [Lawson-Smith et al., J Hand Surg Glob Online 2026; Briotti et al., HAND 2022]. Moderate.
  4. Hardware prominence and removal. The subcutaneous dorsal plate is a recognised source of irritation and a common reason for elective hardware removal once the fusion is solid — expected, not a failure of the operation [Wei & Feldon, JAAOS 2017]. Moderate.
  5. Special populations. In spastic/neurological wrists (e.g. cerebral palsy), fusion changes hand function in nuanced ways — improving positioning but with task-specific trade-offs — underlining that the goal is a useful stable position, not motion [Hargreaves, Warwick & Tonkin, J Hand Surg Br 2000]. Moderate (specialised cohort).

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (SR / meta-analysis): preserved-to-improved long-term grip strength after total wrist fusion; comparable outcomes between CMC-inclusion and CMC-sparing constructs [Lawson-Smith et al. 2026].
  • MODERATE: reliable union, durable pain relief and high satisfaction with plate arthrodesis [Wei & Feldon 2017; Shah et al. 2022]; genuine equipoise between fusion and arthroplasty with motion-vs-durability/complication trade-offs [Cavaliere & Chung 2008, 2010; Jump et al. 2025]; fusion as salvage for failed arthroplasty [Zijlker et al. 2021]; defined complication set (nonunion, hardware removal, DRUJ/digital adjacent issues).
  • WEAK / CONSENSUS: the specific early digital/forearm-motion, union-gated grip rehabilitation programme (mechanistically rationalised — stiffness avoidance — with no dedicated rehab RCTs); exact phase timings (typical, anchored to union rather than trial-derived); stable-fixation early-motion default from technique consensus [Shah et al. 2022; Kalb & Prommersberger 2009].

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Total Wrist Arthrodesis: Indications and Clinical Outcomes. J Am Acad Orthop Surg. 2017. DOI: 10.5435/jaaos-d-15-00424
  • Radiocarpal Fusion: Indications, Technique, and Modifications. J Hand Surg Am. 2022. DOI: 10.1016/j.jhsa.2022.04.002
  • Long-term Grip Strength and Complications After Total Wrist Fusion With and Without Inclusion of the Third Carpometacarpal Joint: A Systematic Review and Meta-analysis. J Hand Surg Glob Online. 2026. DOI: 10.1016/j.jhsg.2026.101022
  • Wrist Arthrodesis Using the Medartis Carpometacarpal Joint Sparing Plate. HAND. 2022. DOI: 10.1177/15589447221141474
  • A Systematic Review of Total Wrist Arthroplasty Compared with Total Wrist Arthrodesis for Rheumatoid Arthritis. Plast Reconstr Surg. 2008. DOI: 10.1097/prs.0b013e318180ece3
  • A Cost-Utility Analysis of Nonsurgical Management, Total Wrist Arthroplasty, and Total Wrist Arthrodesis in Rheumatoid Arthritis. J Hand Surg Am. 2010. DOI: 10.1016/j.jhsa.2009.12.013
  • Arthrodesis or arthroplasty, complete or partial: where are we at in the 21st century? J Hand Surg Eur Vol. 2025. DOI: 10.1177/17531934241296758
  • Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis. J Hand Surg Eur Vol. 2021. DOI: 10.1177/17531934211057389
  • Die vollständige Versteifung des Handgelenks mit der AO-Handgelenk-Arthrodesenplatte (Complete wrist arthrodesis with the AO wrist arthrodesis plate). Oper Orthop Traumatol. 2009. DOI: 10.1007/s00064-009-1905-2
  • Changes in Hand Function Following Wrist Arthrodesis in Cerebral Palsy. J Hand Surg Br. 2000. DOI: 10.1054/jhsb.2000.0366

Wrist-fusion rehabilitation / patient-guidance literature (URLs)

  • American Academy of Orthopaedic Surgeons — Wrist Fusion (Wrist Arthrodesis), OrthoInfo (recovery timeline; fusion heals ~8–12 weeks; the fused wrist no longer moves; therapy for joints not fused). https://orthoinfo.aaos.org/en/treatment/wrist-fusion-wrist-arthrodesis/
  • Wrist Arthrodesis Technique — postoperative care and approach considerations. Medscape eMedicine. https://emedicine.medscape.com/article/1241236-technique
  • Total Wrist Arthrodesis (Wrist Fusion) — procedure and rehabilitation overview. Resurgens Orthopaedics. https://www.resurgens.com/hand-wrist/procedures/wrist-fusion-total-wrist-arthrodesis
  • Full Wrist Fusion — Post-Operative Rehabilitation Protocol (institutional hand-therapy protocol; early digital/forearm motion, union-gated grip strengthening). Alaska Orthopedic. https://www.akortho.com/wp-content/uploads/Full-Wrist-Fusion.pdf

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees


Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


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