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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  
111 Responses
Avatar universal
MEDICAL PROFESSIONAL
For avascular necrosis you cannot revive the bone so the movements at your wrist are restricted now.
So the solution as your orthopaedician has suggested in bone fusion to help you out with proper movements.

You would need physiotherapy after the fusion and you will slowly get some movements but the range of movements will never be similar to as before.

Discuss all the pros and cons and do's and dont's with your operating surgeon and we advice you to choose a person who is adept in this and has expirience. Take care!
1000775 tn?1256918922
Hello Dr Vinod,

Thank you for your reply.

I am well aware of the fact that the wrist will never be as before, and I have at this point quite a lot of information about the 4-corner procedure. The thing that I fear the most are >> the complications from this surgery <<. Since I am 29 and I plan to live a long, healthy life, I'd like to avoid problems down the line.

Nowadays I have almost no extention or flexion movements. If I wear a wrist split and do no sports besides jogging (before did sports almost every day), I'll have no pain. But I also would not like to be wearing a wrist splint for the rest of my life. I also have to wear the splint while sleeping, so that I do not bend it accidentally.

I have read a lot of bad stuff on the internet about the spider plate too, so I wonder if it would be better to use K-Wires instead of the plate.

Given the X rays of my wrist I posted on my profile (one from Jan 2009, the other one from Aug 2009, so just from 15 days ago) and what I have described, what would you suggest, as a physician? Would you go for the surgery or continue wearing a splint? What is also your opinion about the spider plate? Is it reliable?

Thanks again in advance for your support,

- Lerry
Avatar universal
MEDICAL PROFESSIONAL
We were trying to advice you that the procedure if done by experts is problem free and there is no need to wear a splint all your life.

It is your decision for going for the fusion surgery. If you go for it we can say that your quality of life will improve.

Some precautions should be taken, as you should not lift heavy weights, you cannot pull heavy weights but other activities are fine.

With Physiotherapy and over a period of time you will gain strength in your wrist but what we mentioned was it will never be same as before.

The plates and wires are all depending on case to case and surgery and leave it to the   expert. ( You can always suggest your operating surgeon about wires)

Take care!
1027575 tn?1390964018
Hi lerry, first off i'm at a point of having my wrist fused. i'm in constant pain. the questions i have to ask myself is with a partical fusion will i have arthritis in a few years in the area not fused and will i have to go through this all again. i like you am extreemly active or at least was.  i am leaning to have a full wrist fusion.  i wouldn't listen to a thing that doctor responded to you.  look at his back ground he's a general practioner, he's not a orthpedic doctor. about a month has gone by since the post so i would be interested what you decided,  thanks   Phill
Avatar universal
I too am faced with inevitable four corner fusion or proximal row carpectomy.  I broke my schaphoid 40 years ago and never knew it.  it's been painful for 30 years, and now necrotic and collapsed it is time.

I'm very glad to see this string as I have searched the internet for years for information and support with this problem.  I am an avid surfer, gardner, and guitar player and treasure the use of my hands.  

I want to talk to others who have been through this and can provide support and advice on procedures, doctors, etc. (I had my hip replace 2 years ago and there were numeroous web-based bulletin boards with tons of information and support.)  I have not found that for SNAC wrist problems.

Any suggestions?  If there is no group we should create one....there are others out there who need it too.
Avatar universal
I too am faced with inevitable four corner fusion or proximal row carpectomy.  I broke my schaphoid 40 years ago and never knew it.  it's been painful for 30 years, and now necrotic and collapsed it is time.

I'm very glad to see this string as I have searched the internet for years for information and support with this problem.  I am an avid surfer, gardner, and guitar player and treasure the use of my hands.  

I want to talk to others who have been through this and can provide support and advice on procedures, doctors, etc. (I had my hip replace 2 years ago and there were numeroous web-based bulletin boards with tons of information and support.)  I have not found that for SNAC wrist problems.

Any suggestions?  If there is no group we should create one....there are others out there who need it too.
1000775 tn?1256918922
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
1000775 tn?1256918922
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
1000775 tn?1256918922
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.
1000775 tn?1256918922
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.
Avatar universal
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.
1000775 tn?1256918922
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...
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