Wrist Partial Fusion — Four-Corner Fusion (Wrist Salvage)

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE

Key Restrictions

No lifting/pushing/pulling >5 lbs; no WB through involved UE; wrist cock-up orthosis at all times except hygiene; if K-wires used, immobilize wrist 6 weeks; PROM cautious — do not exceed expected AROM; Dr. Salyapongse immobilizes wrist until 4 weeks; no restrictions at 10-12 weeks

Timeline & Phases

Phase I (7-14 days): custom wrist cock-up orthosis, AROM wrist/forearm/digits, edema/scar management; Phase II (3 weeks): continue AROM, initiate Dart Thrower's motion AROM; Phase III (4 weeks): proprioceptive retraining, light activities without orthosis, wrist isometrics, wean orthosis; Phase IV (5 weeks): initiate gentle PROM wrist/forearm; Phase V (6 weeks): progress PROM with prolonged low-load stretches, light strengthening without weights; Phase VI (8 weeks): progressive strengthening (putty/exerciser/weights/bands), dynamic orthosis if AROM gains poor; 10-12 weeks: no restrictions

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Proximal Row Carpectomy protocol; 4CF involves scaphoid removal and fusion of lunate, capitate, hamate, triquetrum with spider plate; indications: SLAC/SNAC wrist; expected AROM per Saltzman 2015: extension 39°, flexion 32°, radial deviation 14°; expected grip 74% contralateral; do not exceed expected AROM with PROM; Dart Thrower's motion maintained post-surgery — radial extension decreased to 53%, ulnar flexion to 84%; maximum recovery at 12 months; published May 24, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-05-24