Here is a list of complications that may occur in hand surgery.

The majority of my cases do not have complications but you need to be aware that they can occur. The consultant will be discussing these with you in person should you require surgery at the time of your consultation. But also we are more than happy to see you for a separate clinic appointment if you require more information over and above what we discussed and what is contained below.

A consent discussion is always required and is useful as it makes us all appreciate that things can go wrong, and surgery should always be viewed as a last resort having explored non operative options including:

  • Do nothing and allow the natural history of the condition to unfold
  • Rest and Splinting
  • Physiotherapy and hand therapy
  • Injections – cortisone etc.

Here are some of the commonly discussed complications but fortunately in the hand they are all quite rare.

Failure to resolve symptoms

Our aim is to improve your symptoms.  On rare occasions unfortunately, this may not occur and may be related to your case complexity.

Infection

The hand has an excellent blood supply and therefore post-operative infections are rare. Signs of infection would be redness, pain and swelling around the surgical site developing after a few days (3-10 days) rather than immediately post operation (1-2 days) which may be a normal reaction to surgery. Very occasionally, about 1 in 20 patients develop a small pin head size of pus around the suture site. This usually needs popping. If this occurs simply send me a photo for reassurance

If you have any concerns, please do not hesitate contact the consultant via the office to review your wounds.

Most infections are superficial and can be easily treated with dressings or oral antibiotics. More severe cases may have a deep infection that require a further operation to clean the wound or intra venous antibiotics as an inpatient.

Ongoing pain

After any operation there will be some pain. We would hope that the majority of discomfort will settle within the first few days of the operation. The type of operation will predict the duration of post operative pain. The consultant will discuss this with you in clinic if needed.

Swelling

All wounds swell after an operation and the majority of swelling will have settled within the first week. Swelling after 1-2 weeks would need reviewing.

Bleeding

General ooze into the dressings may occur after an operation and is preferable than allowing the blood to remain in the wound developing a haematoma (collection of blood) which can be prone to infection. Continuing bleeding after a few days would be very rare and would need review. A haematoma is a collection of blood under the skin and if very large, though rare in the hand, would need releasing.

Scarring

A scar on the hand heals very well and is often barely noticeable. The Hand Doctor Consultant uses both dissolving stitches or ones that need to be removed approx. 10-14 day post surgery.

Bruising

Bleeding is inevitable after an operation and sometimes this comes to the skin as a bruise. This will be red after a few days turning black and blue before fading after a week or 10 days.

Weakness

Weakness can be caused by ongoing pain or a restriction of movement. Most operations we do, would hopefully maintain or increase strength, but occasionally patients can experience a mild degree of weakness. Severe weakness would be very rare.

Stiffness

After an operation you may develop internal scarring, which in turn can restrict the range of movement of a joint. We would hope that most of the movement would return but there may sometimes be a permanent restriction of movement. This does not usually cause much in the way of functional problem.

Nerve injury

Nerves are small soft electrical “wires” that transport information to and from the brain from the periphery.

Most nerves are mixed and have motor (movement) and sensory (sensation) roles.

The motor component sends information to a muscle to tell it to contract, while the sensory component carries information back from the skin about a variety of sensations including touch and pain.

Nerves may be injured as part of an injury but in very rare occasions can be injured during surgery. The consultant will take particular care to identify all important nerves during your surgery and retract them out of harms way. Despite this very rarely they can still be injured.

If a nerve is injured, then the function may be affected. Some nerves are bruised (neurapraxia) and recovery may occur over a few months. Some nerves are permanently injured and therefore recovery is not possible leaving areas of numbness and weakness to a muscle or group of muscles.

Neuroma

A neuroma occurs when a nerve is injured. The end of the nerve that is cut or damaged overgrows and forms a knot of nerve tissue that is very painful. Neuromas can be difficult to treat. Common treatments include hand therapy to desensitise the area, neuromodulation (using variety of techniques including vibration to re-educate and settle the nerve end) and ultimately surgery to locate the neuroma and bury into a protective environment such as an adjacent bone or muscle.

Numbness

Numbness may occur if a sensory nerve is bruised after an operation and recovers over a 3-6-month period. If a nerve is cut, then sensation may never recover.

Tendon injury

Tendons are cord like structures that connect muscles to bone allowing the contraction of the muscle to pull on the tendon and move the bone and joint. Tendons can be injured in surgery and this would affect the joint(s) moving. Tendons are identified during the operation and protected but very rarely they can be injured. Some tendons can rupture spontaneously and this can occur after a wrist fracture treated in a POP, or if a tendon passes over a rough sharp edge of bone or in some diseases such as rheumatoid arthritis.

Complex Regional Pain Syndrome (CRPS)

CRPS can occur after any injury including surgery. As its name suggests it is a complex condition with many factors at play. To reduce the risk of it occurring we always recommend to move the hand and fingers as soon as possible after surgery and keep them moving. Sometimes fingers and wrists are immobilised after an injury or operation and cannot be moved but all the other joints should be kept moving.

CRPS causes redness, swelling and pain. In severe cases the hand may become red and shiny and abnormal hair growth forms. In my personal practice this is very rare (less than 0.5%).

The consultants always use hand therapists post operatively and are sure they are the reason for low rates of CRPS.

Instability

Joints are connected to each other by ligaments. Ligaments can be injured in an accident or during surgery. Hand Doctor Practice consultants are aware where the important ligaments are in the hand and will avoid injuring them. However sometimes after operations such as joint replacements or joint reconstructions the ligaments do not function as well causing instability (abnormal excessive movement of a joint) and ultimately dislocation when the joint comes out of socket.

Dislocation

This occurs when a joint – artificial or the original joint comes out of place. Pain and reduced movement occur. The treatment is usually to put the joint back into place and stabilise with either a splint or in rare occasions another operation to revise the artificial joint or stabilise it.

Joint replacement

Joints that are replaced are artificial and may wear out over time. In such cases they may need revising to a new implant.

Furthermore, when placing an implant into the body the surrounding bone can be fractured and so great care is taken to avoid this. Depending upon which bone is affected would depend upon what is required to resolve the situation.

Compartment Syndrome

After an injury or major operation swelling can occur in the limb. The swelling may be conscripted by the surrounding firm fibrous bags inside the hand and arms.

Pain starts to develop along with swelling and each hour gets worse and worse and is disproportional to the pain one would normally expect. Tingling in the fingers is a very late stage and extreme pain is the main symptom particularly on moving the fingers. This is a surgical emergency and the pressure needs relieving by a trained doctor often removing the dressings and cast but sometimes releasing the tight fibrous bags in the arm with open surgery.

Cold intolerance

Cold intolerance is poorly understood and can occur as a result of injury to the fingers including surgery. An abnormal response may occur to cold environments and cause colour change, pain, stiffness and altered sensation. It generally improves after injury but symptoms after 18 months may be permanent.

Removal of metalwork

If you have plates and screws inserted it may be necessary for these to be removed once the bones have healed in a separate operation.

Non union / Mal union

Bones usually heal without problems.

Bones need to heal in a variety of situations including after a fracture, after an operation to fuse a joint or after an osteotomy (intentional operation to cut off a bone to improve its shape). However, some bones are prone to not healing either as a result of an injury or after an operation. If a bone fails to heal it is called a non union and if it heals in an abnormal position it is called a malunion. Non unions can be either painful or painless.

If after a joint fusion operation, the bone does not heal and is painful they this may need further surgery. If a non union is painless it may be stable and not require intervention.

Smoking is known to affect bone healing and should be stopped several months before surgery if outcome is to be optimised.