At a glance
Main symptoms
- Persistent wrist pain despite passage of months
- Visible wrist deformity
- Persistent range-of-motion restriction
- Hospital stay
- 1-2 overnight hospital stay is typical.
- Recovery time
- 8–16 weeks
- Return to work
- Desk work in 4-6 weeks, light hand activity in 2-3 months, heavy hand work in 4-6 months.
Wrist fractures heal excellently when treated early and correctly. However, inadequate treatment, lack of immobilization, or follow-up failure can lead to malunion (malunion) or non-union (nonunion). In these cases, the wrist becomes painful, weak, and dysfunctional. Surgical treatment of delayed wrist fractures is a complex area requiring advanced planning and precise technique.
Symptoms
Findings accompanying malunion or nonunion include:
- Persistent wrist pain despite passage of months
- Visible wrist deformity
- Persistent range-of-motion restriction
- Significant decrease in grip strength
- In some cases, finger sensory changes (median nerve compression)
- Changes in radial/ulnar variance at the wrist
Diagnostic Methods
Detailed clinical examination and comparative X-rays of both wrists are needed. Standard CT is used for 3D analysis; bone positions, angular values, and joint surface disruption are measured with millimeter precision. MRI shows soft tissue and cartilage damage. These images are critical for surgical planning.
Treatment Approach
Non-Surgical Treatments
Conservative treatment of malunion is limited. Painkillers, splint use, and physical therapy partially relieve symptoms but do not correct structural deformity. Most cases need surgery because progressive arthritis will develop.
Surgical Treatment
Surgical options are planned per deformity: corrective osteotomy (controlled re-fracture and reposition with stabilization), bone grafting (especially in nonunion cases, using iliac crest or distal radius bone), plate-screw fixation. For irreversibly damaged joint surfaces, partial or total wrist arthrodesis/fusion is an alternative.
Surgical Process
Performed under regional or general anesthesia. Procedure may take 2-3 hours. Computer-assisted 3D guides may also be used. After osteotomy, bone is stabilized with plate-screws; graft is added if needed.
Hospital Stay
1-2 overnight hospital stay is typical. Pain control and initial wound care are important.
Recovery Process
- Weeks 1-2: Splint, swelling control, finger movements
- Weeks 2-6: Soft tissue healing, controlled movement
- Weeks 6-12: Bone healing, physical therapy intensifies
- Months 3-6: Strengthening exercises, grip improvement
- Months 6-12: Reaching maximum function
Return to Work
Desk work in 4-6 weeks, light hand activity in 2-3 months, heavy hand work in 4-6 months.
Potential Complications
Since it is complex surgery, risks are slightly higher than standard wrist surgery: delayed bone healing, infection, nerve injury, implant failure. Temporary pain and tenderness in graft donor area (e.g., hip) may occur.
Frequently asked questions
How long can I wait after an old fracture?
Ideally, corrective surgery within the first year gives better results. However, even old fractures (5-10 years) can be corrected; success rate decreases but significant improvement in function and pain is still possible.
Will my wrist be like before after surgery?
The target is 80-90% of pre-trauma function. Full normal is hard to achieve, but significant pain reduction and functional improvement are expected.
What if arthritis has started?
If advanced arthritis is present on the joint surface, partial or total arthrodesis (fusion) or in selected cases arthroplasty is preferred over corrective osteotomy.
This content is for information only and does not replace examination, diagnosis or treatment. The right treatment for you is decided after an examination.