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1000775 tn?1256915322

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

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  
111 Responses
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Avatar universal
Hello.

I am a competitive ice hockey player facing a scaphoidectomy and four corner fusion. Did you end up having the procedure? If so, were you able to ever play hockey again?
Helpful - 0
1 Comments
Did u end up having procedure...thoughts? I'm having it in a few months and I'm worried
Avatar universal
Hi, this is an update. I am now 2 weeks post-op. My original cast was removed, stitches out and had a splint made. All is going well and I can now exercise my fingers and remove the splint to shower. Pain is much more reduced.
Helpful - 0
Avatar universal
Hey, I'm 5 days out of having the scaphoid removed and having the four corner fusion. The post-op pain in my hand and wrist is often a12 on a scale of 1 to 10, but what I have read and just judging by the amount of painkillers prescribed,  this was to be expected. I definitely feel my condition is improving and according to the doctor all went well. I am a very positive thinker and believe that the pain is worth it in the long run. I have a very good doctor and after much consultation I am 100% sure that this is surgery was the way to go. I will repost soon.
Helpful - 0
Avatar universal
I am 36 years old, a percussionist and I also have avascular necrosis of the scaphoid.  I did an arthroscopic debridement surgery on my right wrist last Monday. Now I have an appointment with the doc on Tuesday to talk about the scaphoid excision and 4 corner fusion surgery. This blog has been really helpful for me, thanks to everyone's comments. I am not willing to do the surgery right now, I am controlling the pain wearing a splint made of aluminium, not taking any pain killer although all the docs recommended me, my flexion is quite normal and my extension is about 40 degrees.  If I decided not to do the surgery, how bad will it get? How long will it take to get really bad? I hope I will be able to maintain my wrist  with no pain. By the way, I didn't stop playing music but changed the way I play and some habits as well... using more my left hand for instance.  
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Avatar universal
How about  FULL WRIST REPLACEMENT Surgery as an option, Greggy?
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Avatar universal
For anyone considering it, I am 21 and have had the four corner bone fusion. The post surgery pain for me was not bad at all, the arthritis initially caused more pain. Although with the limited mobility, the surgery is a good relief for pain. However, I had more than just the scaphoid taken out so down the road, my doctor expects 10 years, I will need a full wrist fusion to get rid of all the mobility. So be aware with a four corner bone fusion, you may be like me and ware out the only metacarpals intact.  
Helpful - 0
Avatar universal
Glad found this forum and has great information.

Same story like many .. my pain is chronic not continuous, i got severe pain may be 10 times in last 5 year, but getting more frequent lately..  3 times in last 1 year and lasts approx a week, I use hydrocodone with ibuprofen to control the pain.
I was unable to decide when to go for the surgery.. My specialist advices that post-pone it as much as i can .. but  i'm worried about how much damage it is going to do and also age / healing.

Is it better to go for surgery sooner? I am 41 yrs old, which surgery is recommended? PRC or 4 corner fusion?  Thanks a lot and good luck to all other guys who is planning for surgery. Thanks
Helpful - 0
Avatar universal
How did you fusion surgery go?? I just had mine 2 weeks ago...
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Avatar universal
Hey guys. Im glad to know I am not the only one who is dealing with this. I'm learning more and more about this process. I'm a big sports person. Have been playing flag football for years. I just had the 4 corner fusion 2 weeks ago. Its been a pain. Knowing what I know now, I may have waited longer, but then again my wrist was hurting so I had to do it. So its been two weeks and the splint on my wrist bothers my incision area, wrist is sore at times, and my doc said I should be making a fist...... no where close. I'm worried about them having to go back in to clear up scar tissue to get more movement with my fingers. Anybody else with this issue? Also can anybody suggest another splint to use?
Helpful - 0
Avatar universal
I am an active 53 yr old female who is scheduled to have a four corner fusion in a few weeksl. It is my dominant wrist and I am in constant pain. I have almost no flexion or extension in my wrist. At times, my whole right arm throbs and aches b/c the limited wrist movement has caused severe tendonitis in my elbow. Does anyone else have a problem with elbow tendonitis because of their limited wrist movement? I have my pre-op in a few days. Does anyone have some good questions I should ask my doctor?
Helpful - 0
Avatar universal
Just had my 4 corner fusion 2 weeks ago. I already have full movement of my fingers. However, my index finger and thumb are numb. I still have a bit if swelling in my hand. My doctor says for me to wait until cast comes off in 3 weeks. If numbness is still present, he will perform carpal tunnel surgery. Has anyone else had this issue? Over all I am very pleased with the results, just want the feeling back in my finger and thumb back
Helpful - 0
Avatar universal
any chance of an update mike. what was the pain you are have been experiencing?  Also, have you been able to carry on with your sports and martial arts?

regards
Lee
Helpful - 0
Avatar universal
anyone heard of 'Pyrocarbon Adaptive Proximal Scaphoid Implant (APSI).' for treatment of SNAC?
i just read a  study article about it dated jun of 2013. there were positive results for all the patients in the study, without need for fusion of the joint. i knew that it had been explored in the past with mixed results, but this is recent, and sounded very positive. ive been holding off on surgery, because i dont want to lose what range of motion i have left.
i look forward to any new developements on this front.....
Helpful - 0
1489669 tn?1288274145
I surf all the time since four corner fusion surgery. My hand hurts at times but not too bad. Its a little tougher popping up but you learn to adapt. Had the procedure three years ago come end of May. At 57 years old I am still riding a short board 6' 2". Would probably be easier if you ride a fun shape or longboard. Bottom line is if you want to do something bad enough you find a way. Good luck with your situation.

      
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Avatar universal
Can you still surf with your scapnoid injury? Have you after surgery from the four corner fusion?

I am an avid surfer, and broke my scapnoid. It didn't reheal after the complete fracture, and was split in half. After being pinned, it didn't heal. I  got hit by a car on my bicycle.
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Avatar universal
Hi ,august 9 th had my 4-corner fusion and scaphoid excision plus work on nerves as well.
Had a car accident in the past.
My dearest hobby is icehockey and I work as an airline captain.
I hope I Can return my profession but I am worried about icehockey- Any hockey players here?
Cheers JA
Helpful - 0
Avatar universal
Hi ,august 9 th had my 4-corner fusion and scaphoid excision plus work on nerves as well.
Had a car accident in the past.
My dearest hobby is icehockey and I work as an airline captain.
I hope I Can return my profession but I am worried about icehockey- Any hockey players here?
Cheers JA
Helpful - 0
Avatar universal
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.
Helpful - 0
Avatar universal
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.
Helpful - 0
Avatar universal
Hello just wondering if any one has created a public bulletin as of yet for broken/fractured schaphoids??
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Avatar universal
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?
Helpful - 0
Avatar universal
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.
Helpful - 0
2212332 tn?1339177197
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...
Helpful - 0
1000775 tn?1256915322
hello all, its now more than 2 years i have done the surgery... i had a quite normal life until about 1 month ago when i started having some wrist pain again... i am waiting to see if it goes away alone, otherwise i'll have to check with the doc... its not pain, but a very uncomfortable feeling that my hand is very tired... i suppose this could be the beginning of an athrosis... cheers
Helpful - 0
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