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1000775 tn?1256918922
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  
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My total range of motion is approximately 80 degrees - 42 flexion, 38 extension.  

I still have a lot of fluid in my finger joints.  Is there any way to get rid of it or does it just take time?  If so how long before the fluid is totally gone?

Thanks
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I wish I could help. I have a great deal of edema myself. I have been using compression gloves and they do help with the swelling. They are limiting, but help with the pain associated with it as well. I am now also battling tendonitis. You go 2 steps forward and one step back. I am hoping to get more flexion, but the end point is solid. I still have hope, though because it would make life so much easier to be able to use my dominant hand for more ADL's.

If anyone has any suggestions on how to accomplish this, let me know!
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Hi, I am glad to hear that you are doing so well.  I've been struggling lately, you know the pain all day and night, and no time to dedicate to my health.  I have my pre-op this Thursday 5/5 (hey, Cinco de Mayo...how fitting) and I am nervous.

I have so much to do around the house before I become invalid and it is overwhelming.  Trash, laundry, lawn, etc etc and I have to get it done prior because if I'm in a cast for 7 weeks...!

I have been thinking about the fusion itself and the associated hardware.  I have really skinny arms, so will the hardware be sticking out? I know there will be a scar, but how long is it?  

I'm really not vain, but a little self conscious so your input would help thanks. :)

Again, glad to hear you're doing great and your help is invaluable!
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Hi - I hope your surgery went well.

The metal plate in my wrist is not visible so no need to worry there.  My scar is approx 3 inches long and not very noticeable with the exception of 1/2 inch that is a little wider and more red than the remainder of the scar.  Hopefully that small section of the scar will shrink a bit over time.  Good luck with your rehab.
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I too was living with pain for years because of a miss diagnosis, because they were too cheap to take an x-ray, so after complaining for a couple of years to several doctors i demanded an x-ray and for sure they found the scaphoid fractured, well i wasn't happy and decided to see about getting it repaired. I came to tolerate the pain though, it was manageable tolerable, i saw several doctors, 6 to be exact and received 3 different suggestions, 2 doctors said leave it alone if you can tolerate it, 2 doctors said to do a total scaphoid ectomy, where they remove 3 bones and the other bones would just drop down in its place and 2 doctors said to do the 4 corner fusion with removing the scaphoid, well after thinking about it and getting more info i went with the 4 corner, biggest mistake of my life, i should of left it alone, i could tolerate it before, and i could still work and play all the golf i wanted and throw a fribee and play baseball, now its been since December 13th 2010 and im in pain more then ever, i still have the same pain as before and developed others now more painful then the original pain, and one finger tip is still numb and and i get shooting cold feelings into some fingers when i use my hand, they say maybe a pinched nerve, i still have numbness from the cut nerves around the incision, now they have to do an EMG to see if i have problems with nerves and they want to go back in and fix the tendon, physio cut me loose because i was not getting better with the treatment, so now i cant work and i have tried a few times, but im in pain, and can not last more then 3 hours of work and i suffer for days after, every movement hurts, but i wont let it stop me from living, ill keep trying to go to work and i still go golfing because that's the one thing that's keeping me sane, and those who know golf understand this...I could go on all day and complain, but the bottom line is i should of left it alone, i was use to the pain before and was tolerable, the doctors just said that's because i can tolerate pain better then others, well that's true maybe, i can and they said if i left it alone i would develop arthritis in 5 to 10 years, well maybe but i would cross that bridge when i got there and whats not to say i wont get arthritis anyway, what do they think is going to happen anyway, i would be all better, no way, well my last comment is its was an unnecessary procedure in my case, all cases are different, if you can learn to live with the pain, then do it, don't go with the surgery, let life take its course, because the fusion is not reversible....
thank you...

Painfully
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I'm only 22 years old and I found out 3 years ago that I had avascular necrosis of the scaphoid bone as well. I have not done the fusing yet. Mainly bc it's my right hand and well I'm right handed. But also bc I'm not ready to lose it. My grandfather has had the partial fushion and he since has still been in a lot of pain. My doctor told me that the partial fushion will only last for like 10 years and after that they'll have to completely fuse it.
I know eventually I'll have to have the surgery. The pain is really hard to deal with. But hopefully my waitings paid off. I just heard of a surgeon who replaced the bone with a cadaver bone on someone who has the same injury. It worked perfectly. I'm hoping I can get the same precidure.

I'm finding my whole situation hard to live with. I still have my whole life ahead of me. So I'm going to keep searching for an alternative solution. I hope y'all get the answer you want and everything works out for you. Best wishes!
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I am a 38 year old woman with two young children and a very active life style. I had a four corner fusion and scaphoidecotomy on June 1st 2011 and wanted to let anyone know that is interested how it went. First of all, don't let all the crap on the internet scare you. I suffered a scaphoid fracture when I was young, don't really remember it, and this "injury" came back to haunt me 30 something years later. The doctor called it a SNAC wrist. I have battled pain, loss of motion, swelling, and weakness for about a year and contributed it to carpel tunnel or something. With two young children, I just lived with it and went on. Finally in May, I went to see an orthopedic hand specialist and he was absolutely wonderful. You need to find a doctor that will sit down with you and explain to you why, what, when, how and where. You have a right to know what is wrong with you and what they will do to fix it. You have the right to discuss k wire vs screws, etc. I elected to have k wires. Surgery went well. I spent the night at the hospital so they could control my pain. They gave me a nerve block in my shoulder that kept my nerves bathed in numbing medicine so for the first three days, I felt nothing at all. I was in a splint for about 11 days, went in and got my stitches removed. I had an xray done to make sure that my bones were fusing correctly and they put me in a hard cast to below my elbow. I am going tomorrow to get my cast removed, another xray done and another cast put on. I will probably wear a cast for about 2 more weeks and then go in to have the k wires taken out. That is a procedure as well. I will be sedated but not put to sleep, they will numb my hand and take the wires out. I will immediately start physical therapy right after that and get fitted with my splint that I will wear for about 2 months. Its a long road but I was only down for about a week and I have managed to keep my house, take care of my kids and do what I need to do. I have pain sometimes but I keep it controlled with rest, cold packs and meds. I am off work right now due to the fact that I type most of the day on a computer. I hope to go back to work when the wires come out. I hope this helps. Its not bad and I am glad that I did it. I was scared slap to death but the key is to have a good doctor that will walk you through the steps. If you don't feel comfortable with your doctor, find another one. I did. My first doctor just told me to keep wearing my splint and come back if it doesn't get better. If you have any questions, just let me know. I will post how my doctors appointment went tomorrow.
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Hi, i've had a full fusion in my dominant wrist and a four corner fusion on the other. I have very few problems with either of them. I get a bit of pain in my partially fused wrist but nothing like it was pre-op. I still ride my motorcycle but use common sense to decide what i can and cannot manage; the biggest problem with a total fusion is wiping your bum.
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I am 50 and crushed my wrist 5 years ago. I had surgery to repair the wrist which worked fairly well. I went to physical therapy for 6 mos and was able to golf again. The the wrist started to fall apart 2 years later I had an additional surgery to remove the plate. Again was able to golf that summer. I have now not golfed in 2 years and have had 2 additional surgeries to do the partial fusioin. My doctor now tells me my only option is a full fusion. I have been getting cortozone shots for the past 9 months but still in  alot of pain. Full fusion here I come 4 surgeries later what a mistake!
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Did you have a full or partial wrist fusion...I too am facing a partial fusion of my left wrist and anxious to hear how yours is going.  Did you have a k wire or spider plate?  Not sure which my surgeon will do.  I have very small wrists which is a big concern.....Anxious to hear any input
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I am also facing a partial wrist fusion.....Ive been told by my surgeon that although the range of motion will be limited, the wrist will be strong and pain free and I should be able to resume sports like golf and tennis....am anxious to hear what your experience has been.....how much pain and swelling, and what is the projected recovery time?  I hear everything from 2 months to a year.  
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Hi - I'm in my 50s and very active, and also facing a partial wrist fusion....apparently an old injury which now has degenerative arthritis....I was encouraged by you post, and am anxious to hear how your recovery is going?  Can you tell me why they did a k wire?  I am small boned with very small wrists, and this is a big concern for me.  How much pain and swelling have you had?  Anxious to hear any news, and when they expect upi to start rehab.  Barb
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ive had wrist pain for the past 7 years. and 9 wrist surgeries. my doctor told me that my only chance is the four corner fusion. however i am 28 years old and not sure where to do it. wghat should i do?
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I.m also a golfer with AVN of the scaphoid and pain every day.  I have been putting off surgery given all the disparity in posts here post op.  How are you now after a summer of golfing?  did you have the wires or plate?
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I'm also a golfer with AVN of the scaphoid and pain every day.  I have been putting off surgery given all the disparity insuccess discussed in ther  posts here post op.  How are you now after a summer of golfing?  did you have the wires or plate?
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Howzit Blaine ,,after reading your post and an avid golfer too im in the same boat as you and going for full fusion next week. Im left handed but golf right handed and im getting the left wrist fused .I think im glad its the left getting fused  ,shouldnt hinder my swing as much ,what do you think ? how is your wrist doing now ?
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1515580 tn?1290545130
i had surgery #4 yesterday to debride the tfc in my left wrist. I'm 11 months post op from a partial fusion (plate & 8 screws) and my doc found the fusion was stable enough to remove the plate too. I work at a golf course during the summer and wasn't able to play until July when my doc shot the tfc with cortisone. After that, I was able to play 9 holes with minimal pain. I also bought a motocross brace from ****.com for about $25. Best $$$$ I ever spent. Good luck
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50 yrs young!!! I had partial wrist fusion Dec 2010. Next week Jan 2012 the plate and 8 screws to come out. Looking forward to that as its done the job. I have relatively thin wrists. Pain was considerate post op though I would go through it 10 times for the result I have. Active now as I was 15 yr ago. Yee hah. I work with my hands and find that having a stiff wrist hinders my ability very very little.  I certainly recommend the procedure when performed by a reputable competant surgeon.  I also recommend the external use of Comfrey (knitbone) ointment and the oral dose of symphytom (homeopathy) for the bones and Hypericum and calendula in sorbeline base for scar healing.
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My daughter is 18 and had the four corner fusion last week. She is a lot of pain right now but I will let you know how it goes. She is in college so this first week with pain and school have been tough. She developed Avascular Necrosis from steroids and chemo treatment for leukemia at the age of 15.
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Interesting reading here.  I am approximately 8 months out from my wreck and have a scaphoid nonunion after a bone graft was done.  I am now looking at having a scaphoid excision with a four corner fusion.  My motion is so little now that the doc says I may actually regain some motion after the surgery.  I'm just ready for all of this to be over as this will be my fifth surgery since the wreck.  
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I am exactly one year from having my schapoid excised and a four corner wrist fusion.  Has anyone experienced severe hand pain around the metacarpals post surgery. I have bad pain in my hand all the time, especially when I use it or try to grip hard or push of the ground, things like that.  Also my motor function is not all back.  Maybe 50 percent.  I am a 32 year old athlete.  Has anyone experienced similiar problems so far after surgery, it seems like to me?
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2000923 tn?1327439013
I have very good doctors here where I live but they were so pessimistic I started researching hard.  I went to the hospital for special surgery in New York to have Dr. Weiland do mine. He is an incredible surgeon.  I think the reason you see so many different results on this blog is the quality of the doctor! Weiland is the choice of professional athletes  that have wrist issues and they usually find the best. I am 2 months removed from my surgery and very optimistic. I hope to be golfing in 2 months pain free!
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2000923 tn?1327439013
I am in week 5 with the same procedure. Tell her first 2 weeks were the worst. I have a high pain tolerance but it was unbearable! Week 3 was a little better with 4 &5 improving a bunch. The key is to keep that thing elevated at all times and after swelling goes down gentle finger exercise helps tremendously. My fear is that I would somehow "hurt" the surgery but my doctor told me not to worry about that. Light pressure back and forth on fingers will help with recovery down the road. Good luck to her.
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2000923 tn?1327439013
Great post. I had the same procedure 2 months ago. I get my cast off today. How are you doing now? How long did it take to get back to normal? Pain gone?
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HI Lerry, I too have suffered for about 10 years with severe wrists pain, i did the splint thing too.  Now im to the point where my left wrist has almost fused itself, i cant bend my wrist anymore which is difficult as you know. My doc gave me the same options as you, he also mentioned wrists replacement, which is fairly new, but u may want to inquire about it. i have still yet to decide what to do. i wish i had a diagnosis...did you get one, they mentioned kiebocks disease but my ortho doc and hand surgeon disagree on it.
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I am a 21 year old athlete who broke my scaphoid 5 years ago, although I did not find out until this october when i got my surgery (bone graft and 3 pins). After 19 long weeks in a cast, I finally got my pins out today although the bones are only slightly healed. I do have some arthritis in the joint. Im wondering how long it will take to get back to lifting and playing sports again, and if lifting is even a good idea? Iv always been able to tolerate the pain from this, and even if my wrist went back to how it was before surgery i would be happy.  comments from anyone who has had this problem would be appreciated.
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1000775 tn?1256918922
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
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2212332 tn?1339180797
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...
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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.
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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?
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Hello just wondering if any one has created a public bulletin as of yet for broken/fractured schaphoids??
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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.
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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.
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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
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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
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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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1489669 tn?1288277745
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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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.....
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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
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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
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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?
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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?
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How did you fusion surgery go?? I just had mine 2 weeks ago...
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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
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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.  
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How about  FULL WRIST REPLACEMENT Surgery as an option, Greggy?
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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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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.
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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.
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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?
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