four-corner fusion of the wrist (avascular necrosis of the scaphoid)

[lerrymoe]

Hello, I have developed somehow an avascular necrosis of the scaphoid. The condition happens when the the scaphoid is broken and one of the parts is not supplied with blood and dies. The only good news is that it was not on my right hand, since I'm right handed. The doc wants now to do a partial fusion of the wrist, with excision of the scaphoid and fusing the other 4 bones on the top of the wrist to provide stability. The excision of the scaphoid is said to be the only solution with partial fution of the wrist since I have alredy developed arthritis on the concerned wrist.  

My current situation is the following: almost no extention or flexion on the wrist; all other movements intact. If I keep the hand continuously in a splint i'll have no pain, but if i take it out i'll have pain in a very short time, doing even minor tasks.

Since I am quite young (29yrs) I am wondering what should I do. I dont want to live in pain, but I also know that this surgery will probably not be the end of this story. I know about this since the beginning of the year, and since then I've also done almost no sports. Before that I did sports almost every day.

My question is: has anyone here experience with partial fusion of the wrist? (four-corner fusion). Would you recommend it? What was the outcome?

Thanks a lot in advance,

Lerry  

[lerrymoe]

I decided to have my four corner fusion; so lets see what will be the result. If I am mistaken; I will suffer with this decision the rest of my life. I got tired of listening to what people say; you will hear as many people saying you should do it as people saying you shouldnt. so it is about time to go by myself. will be 1 month in a cast, and hopefully all will be all right at the end

[lerrymoe]

Here is a video of a 4-corner fusion:

http://www.orthop.washington.edu/UserFiles/Media/faculty/Trumble/arthritissurgery/03/a/spider.mov

And here is some more information

http://www.orthop.washington.edu/UserFiles/Media/faculty/Trumble/arthritissurgery/03/a/spider.mov

[lerrymoe]

hi kriyamon, if you are leaving this long with a snac wrist you will probably need a total wrist fusion... a 4 corner fusion is called a partial arthrodesis of the wrist that can be performed given your other metacarpal bones did not go moved so that they occupy the space of the collapsed scaphoid... if this is the case (if the other bones already sunk on the space where the scaphoid was), only total wrist fusion can do it... this usually happens if you live a long time with this problem without doing much about it, and maybe this is your case.

[lerrymoe]

hi kriyamon, if you are living this long with a snac wrist you will probably need a total wrist fusion... a 4 corner fusion is called a partial arthrodesis of the wrist that can be performed given your other metacarpal bones did not go moved so that they occupy the space of the collapsed scaphoid... if this is the case (if the other bones already sunk on the space where the scaphoid was), only total wrist fusion can do it... this usually happens if you live a long time with this problem without doing much about it, and maybe this is your case.

[sozestail]

I also have avascular necrosis of the scaphoid and have been doing a lot of research on the internet.  I was curious if you finally got your partial fusion surgery and how it went.  I have been also reading about scaphoid replacement surgery, was that an option you considered?  I just found out a few days ago that the pain I have been experiencing for years may haunt me forever and I am really trying to find out the best options available to me.

[lerrymoe]

hi sozestail, i will get my surgery on monday, so in 3 days from today!!! f***, i am really nervous; cannot sleep and so on... thought about cancelling it, but that would be really bad for the docs, for the hospital and maybe for me, since i think the insurance would charge me for this last minute decision... anyways, now lets go for it. the thing that worries me the most is that i have not much pain, even though i have almost no flexion or extension on my hand now; my hand is at a point that it already does not move much up or down, so i have little pain. i cannot do any kinds of sports, though; only jogging is ok. so lets say, if you could imagine 3 stages: one where you are normal; one where your wrist if f*** up but you have no pain; and the last stage as the one with your wrist f*** up and you have pain; I am on the middle one. of course with this surgery i would like to improve as much as possible; but no doc would give me any guarantee; so at the end you are by yourself... it is a kind of a gamble with more chances of improvement than otherwise... will keep you posted...