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  

[BlaineA]

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!

[senna878]

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.

[brandy641]

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.

[Lexi1988]

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!

[payingforit]

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

[tomw99]

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.