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  

[cw1710]

I bet you moved your fingers very little post-surgery.  That will make them stiffen up.  I bent mine back and forth several times a day from the day after surgery onward and never had any stiffness in my fingers at all.  It should loosen back up though from what I have heard but it might take a bit.

[alzora]

Hell-o everyone. I had my four corner fusion in February 2012. I don't know if anyone had to have therapy or not, but I do. I have therapy twice a week. They were trying to get 35 degree range forward, but can only get about 20 degrees. Currently they are trying to get the stiffness out of my fingers. As long as my fingers are warmed up first before therapy, you can bend them. After they cool off I can't bend them. I can't make a fist. The back of my wrist is very stiff. Whenever it rains, there are times I am extremely stiff. Like right now.

[kayz83]

Hello just wondering if any one has created a public bulletin as of yet for broken/fractured schaphoids??

[Camcc05]

I am a 38 year old mother of 3. I broke my scaphoid 15 years ago in a car accident. At the time I had 3 surgeries. One to fix scaphoid with a Herbert screw. That didn't work so did a bone graft. After 15 years of relatively little pain or complications, I reinjured the wrist April 2011. After being told my only option with be a scaphoid excision and a 4 pt partial fusion. I had the surgery done february 2012. My ortho said I should be feeling great my may or June! Not the case, I am very active with my wrist and feel extreme pain. I have 3 kids , one being 20 months old. Doctor said I need to use it more. I went for a second opinion and doctore recommended casting for a month to see if full fusion will be needed for pain relief. I have only 3 degrees of flexion.

I'm very frustrated since the doctors are conflicting with treatment plans! Anyone had a similar situation that went from partial fusion to full fusion?

[cw1710]

4 months post fusion now.  My doctor actually removed the scaphoid and the triquetrum and did a 3 corner fusion using memory staples.  This method is supposed to result in better ulnar deviation.  My extension is ver low (something like 30 deg) and my flexion is doing pretty well.  My grip is back up to somewhere around 70lb.  I do still have pains daily if I move it to its extremes or put a lot of pressure on it.  Usually they are minor pains but they can be aggravating.  Just resting my head in my palm can cause it to start hurting after a short time.  Overall, I am satisfied and am optimistic that I will improve a little more but am not sure when or if it will ever quit hurting.  Either way, I'm better off than I was before.

[benfullohell]

hey everyone, i'm a 40 year old male and i'm about to have my scaphoid fused with a bone graft. i was a carpenter, blacksmith and metal smith for 22 years and the impact has blown out the joint. the bone is arthritic and there are 5 bone fragments in the joint plus an avulsed a tendon coming off the scaphoid that took a piece of bone with it. i have limited motion due to all the "gravel" in the joint and if i use a screw gun or hammer for more than a couple minutes i am in extreme pain. i tried PT with lasers and ultrasound and the Ortho gave me cortisone. the PT helped some but since i stopped going the pain is coming back, the cortisone helped a little for about 3 days then i was right back at square 1. my surgery is scheduled for july 30th and i am still not sure if it's the best idea but i have tried everything over the past year with nil or limited results. i am also an Aikido instructor and this mess has kept me off the mat for a year, plus i haven't been able to kayak or golf either. the doc wasn't too excited about operating on me but when i told him all i had done he agreed it was the next logical step. i just hope i'm doing the right thing...