Hand, Wrist and Elbow Unit

Scaphoid pseudarthrosis occurs when a fracture in the scaphoid bone of the wrist fails to heal, forming a ‘pseudoarthrosis’ that results in persistent pain and joint instability. This bone has limited blood flow, making healing difficult. Treatments include internal fixation with screws and the use of bone grafting to promote bone fusion to restore stability and function to the wrist.

Osteoarthritis in the radiocarpal and midcarpal joints is due to chronic wear of the cartilage, causing pain, stiffness and limited movement. Over time, the cartilage deteriorates and the subchondral bone begins to be affected, resulting in pain and progressive loss of function. Initially, physiotherapy, anti-inflammatories and joint protectors are used for management. In advanced cases, a fusion surgery called arthrodesis can be performed to stabilise the joint or a joint replacement can be performed, which relieves pain and improves functionality.

Flexor tendon injuries in the hand and wrist, even after repair, can result in fibrosis, adhesions, or partial rupture, resulting in restricted finger motion and loss of strength. In these cases, reconstruction or adhesion release surgery is necessary to restore motion. This may involve tendon grafts or tendon transfers, followed by a specific rehabilitation program that includes physical therapy and dynamic splinting to maximize functional mobility.

Wrist arthroscopy is a minimally invasive procedure that allows the diagnosis and treatment of internal wrist pathologies, such as ligament and cartilage injuries, synovitis (inflammation of the synovial membrane) or the presence of loose joint bodies, among other pathologies. A camera and specific instruments are introduced through small incisions, which generally results in a faster recovery and a lower complication profile.

Elbow arthroscopy is also a technique that allows the treatment of very diverse pathologies of the elbow joint such as loose joint bodies, post-fracture stiffness, cartilage injuries, or to release compressed structures at this level.

Peripheral nerve microsurgery focuses on repairing or releasing traumatically damaged peripheral nerves or those that suffer from prolonged compression (such as carpal tunnel syndrome or cubital tunnel syndrome). Using microsurgical techniques and high-precision instruments, neural tracts are realigned or grafts are used to resolve different situations. Post-surgical axonal regeneration allows for gradual restoration of sensitivity and motor function, although full recovery may take long periods depending on the severity of the injury.

Replantations are complex surgical procedures that aim to restore amputated parts of the hand, such as fingers or entire limbs. This involves reconnecting blood vessels, tendons, muscles and nerves using microsurgery, which requires advanced expertise in replantation techniques. The viability of a replant depends on the time elapsed since the amputation and the condition of the tissue. Following surgery, a long and specialized rehabilitation program is essential to achieve the best possible recovery of function.