Melbourne Hand Surgery 


Latest news: Masks are and will remain mandatory when you attend our practice in person, and we request that you log your attendance via our Victorian Government QR code, by entering location code 3D7RE3 into the Services Victoria App or by writing your details on the physical register at our reception.

In accordance with the current COVID peak (black) status consultations are now being conducted via videoconference, with in person consultations by exception. All individuals undergoing elective surgery are required to obtain a negative COVID test within 72 hours of their scheduled surgery and must self-isolate from the time of their test until their hospital admission.  Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden has closed. We are currently experiencing critical administrative staff shortages and we are changing our service delivery models to manage this. Our offices are currently closed on Friday.

Videoconsultations are conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. For in person consultations we have enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.      If you are eligible to get vaccinated, please do so. 

Total wrist fusion

elderly handsTotal wrist fusion is predominantly performed for severe wrist arthritis. A total wrist fusion stops all movement at the wrist joint, so it is not an operation to undertake lightly. However, it provides welcome relief for patients who are unable to use their hand due to wrist pain and instability.  

The severe arthritis that leads patients to a total wrist fusion can be the result of a number of conditions. Sometimes damage to the wrist ligaments as a young adult sets up changes in wrist biomechanics that lead to progressive arthritis. Sometimes rheumatoid arthritis is the underlying cause. There are also other uncommon reasons patients may undergo a wrist fusion – when part of the wrist has to be removed due to cancer or infection, or when there is paralysis of the wrist or hand.

rheumatoidarthritiswristfromRadiopaediaDOTorgWhen to have a total wrist fusion

Total wrist fusion may be performed after a (failed) partial wrist fusion, after a (failed) joint replacement or after surgery for major trauma (or tumour) at the wrist. It can be used as a “surgery of last resort”. It can also be used in younger patients who face progressive arthritis and wish to have a single operation and recovery, rather than try a partial fusion.

How will the loss of movement affect me?

Most activities can be performed despite the loss of wrist movement. The most difficult activity is toileting (most people find that they need to hold the toilet paper in their unfused wrist when wiping themselves). Lifting a glass from a low table is problematic, as is picking up coins from a table. If you want to know how the limited range of motion will affect you simply try wearing a splint that holds you in the position that you will be fused in.

What does the surgery involve?

The surgery involves having a metal plate will be placed across the wrist joints, preventing movement. The cartilage surfaces of the wrist bones will be removed, and bone graft placed between the gaps to facilitate bone-to-bone fusion. The bone that is used for grafting is generally taken from the bones around the wrist that is undergoing the fusion. Discuss with your doctor whether excision of the nerves that transmit pain from the wrist would also be suitable for you as part of this operation.

hands undo lockPost operative management

After the surgery you will be immobilised in a cast for 6 weeks. This is necessary to ensure that there is no movement at the fusion site, to maximise the chances of the bones successfully uniting. In the normal post operative course you will begin strengthening exercises at 8 weeks, and be allowed full use at 10 weeks. Your post operative strengthening and recovery will continue for many weeks; many patients report that they are not fully recovered until the 6 month stage and grip strength often continues to improve until the 12 month stage.


Complications may include ongoing pain, non-union (failure of the bones to fuse), plate or screw fracture or loosening, worsening of carpal tunnel syndrome, an unsightly scar and rubbing of tendons on the plate leading to rupture of tendons.


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