The main risks with surgery in the hand/wrist are ...
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Infection: generally should be of the order of 1-2%, so low risk, and superficial infection should settle easily with antibiotics or when the stitches come out.
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Stiffness: much more likely if there has been an infection, or if pain and swelling restricts mobilisation after the procedure. Over-cautious splintage will also cause stiffness. Hand therapy will help with this.
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Nerve injury: some numbness is common for short periods but often settles as swelling disappears. More persistent numbness or altered sensation is something that all hand surgeons worry about and strive to avoid. Some operations carry higher risk than others, but significant nerve injury is rare (1-2%). Altered sensation can be treated by further nerve surgery or desensitisation by a Hand Therapist
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Tendon injury: will be repaired as it happens, if it happens. This may affect the result. Inadvertent tendon injury is very uncommon.
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Fracture surgery: non-union or mal-union (failure to heal or healing in a bad position) are the main complications of all fracture surgery. Uncommon – in the region of 10% or less.
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Metalwork removal: failure to remove all the metalwork as a result of damage to the screw heads or metal fatigue and fracture of screws is well recognised. Careful preparation should avoid this in most cases as ‘broken screw removal kits’ are available now. Holes left in the bone after screw removal are prone to re-fracture for a few months, particularly if the hole is of the order of 1/3 rd of the bone diameter, so this should be borne in mind.
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Persistent symptoms: failure to resolve all of the symptoms occasionally occurs. More serious persistent pain, stiffness and swelling may signify complex regional pain syndrome (CRPS) and this needs urgent care with Hand Therapy and often a Pain Specialist
Consent for Medical Procedures
Resources to Prepare Patients for Medical Procedures
When considering surgery to the hand & wrist, it is important to be cautious. I tend to avoid operating on anyone who seems to be improving. I only operate if I think there is a good chance of reducing pain or improving function or both. The amount of benefit has to be worth the rehabilitation and can be safely offset against the risks.
