Wrist Four Corner Wrist Fusion

[rdgallo]

I would like to know some personal experiences from members on this fusion. Thanks!

 

[Jaycey]

@rdgallo We don't have many members in the wrist area of our site. But let's see if they stop by with input. Is fusion something you are considering?

 

[rdgallo]

Yes, the four corner fusion is what the doc suggested along with some other work.

 

[Jamie]

How about telling us a little about how you got to this point, @rdgallo? It would be helpful to know the background of your problems.

 

[rdgallo]

How about telling us a little about how you got to this point, @rdgallo? It would be helpful to know the background of your problems.

Well, about a year and a half ago, my right wrist started swelling up and hurting due to arthritis (not rheumatoid..I have been tested). Shortly after that, the left wrist did the same. I have been getting cortisone injections in both wrists about every three months since. In November of last year I had Dr. Quervain surgery and a denervation surgery on the right wrist/arm. It did not seem to help much. Both wrists are very painful and the left is now hurting worse than the right. I had an MRI done on the left wrist and it showed several issues...severe arthritis. tendonitis and a ganglion cyst. The doctor has recommended four corner fusion and he said he would address the tendonitis issues and the ganglion cyst at the same time. I told him I did not want surgery until November as I did not want to be in a cast during summer, but I am not sure I can take the pain much longer. I am scheduled for cortisone injection on both wrist again later this month. I was hoping to hear from some people who have had the four corner fusion, but it appears no one on here has had that surgery. Thanks!

 

[Jamie]

You're right that we don't get a lot of wrist patients on BoneSmart quite yet. But let me tag our forum Nurse Director, @Josephine, to see if she has an experience with this procedure. Thanks so much for providing some background information for us. It helps.

 

[rdgallo]

You're welcome. Thanks for your help.

 

[rdgallo]

Well, I guess no one on here has any info on the four corner fusion. I guess I will have to just do a search on Google and settle for whatever info is out there. Thanks anyway.

 

[EmEm]

Hi @rdgallo
I'm not on the forum much but I have written on here about my total wrist fusion. I don't know anything about the technique you are considering but I can tell you about having a fused wrist with a titanium plate.

Problems with my wrist started a long time ago and when pain increased and the gaps between the cortisone injections got shorter my GP sent me to a wrist surgeon. After an MRI scan, he told me I had arthritis in several areas - the proximal and distal row of the carpus, the radiocarpal joint and the first carpometacarpal joint. The most severe area was the first in the list which would be addressed by the fusion.

After the surgery and 5 weeks in a plaster cast I recovered well and began to adapt to the lack of flexion. I'm not sure how your surgery differs but I can't bend my wrist at all but can rotate it. I have complete use of all my fingers and can do most things but can't pick small things up off the floor or cut food easily with a knife and fork. There are ways round both! I managed to work (using a computer) and drive within 6 weeks of the surgery.

Three years on the fusion is fine and that area pain free but the other areas are beginning to be a problem so I am now considering a trapeziectomy and ulnar shortening. The latter to stop the two bones clicking painfully against each other. I may also have the plate removed from the fusion as it's no longer needed and may be irritating tendons.

I don't regret the fusion surgery but realise now it was never going to be the complete answer. I wish you well with whatever you decide to do.

 

[rdgallo]

Thank you, EmEm for the information. It is my understanding that with the four corner fusion, I will still have some bending of the wrist. I cannot bend it much right now so am looking for pain relief. If the left is successful, I will have the right wrist done too as it is almost as bad as the left. Thanks again!

 

[VSlowLife]

@rdgallo Hello, so sorry your wrist has a few issues. I have bone marrow edema in my wrist ( super bad OA) which never seems to go away. The hand therapist made me a day brace with a sleeve liner and a night brace with a double layer sleeve liner to keep it more comfortable. I do not know if that would help you. I was also prescribed Pennsaid which is a pain gel NSAID. It worked better at the start on the pain,and the great thing is no one can tell you have an issue. Sometimes I take a section of my prescription 5% lidocaine patches for my hip, and use it on my wrist with cloth medical tape.
I hope it all works out for you.

 

[marieltha]

FYI, @Josephine just had knee surgery. She should be back sometime soon. I will be very surprised if she does not have some feedback for you. She is very knowledgeable.
Good luck.

 

[rdgallo]

@rdgallo Hello, so sorry your wrist has a few issues. I have bone marrow edema in my wrist ( super bad OA) which never seems to go away. The hand therapist made me a day brace with a sleeve liner and a night brace with a double layer sleeve liner to keep it more comfortable. I do not know if that would help you. I was also prescribed Pennsaid which is a pain gel NSAID. It worked better at the start on the pain,and the great thing is no one can tell you have an issue. Sometimes I take a section of my prescription 5% lidocaine patches for my hip, and use it on my wrist with cloth medical tape.
I hope it all works out for you.

Thank you for the information. I hope things get better for you.

 

[rdgallo]

Well, I have been absent from this forum for awhile and thought I would update my original post. I had my 4 corner wrist fusion on Jan. 29th of this year. Long story short....it was not successful. The surgeon only used one K wire through the Capitate and into the Lunate for fusion fixation. He used no other hardware and consequently no fusion took place. I had a CT scan ordered by a different surgeon last week (the original surgeon passed away of a Glioblastoma in May of this year). The results showed no fusion at any of the carpal bones that were supposed to be fused. It also showed what appear to be bone cysts on the Lunate. I am scheduled for a revision 4 corner fusion surgery on Dec 8. If what appeared to be cysts on the CT scan are real and in a bad location, the surgeon said he would have to do a total fusion of the wrist. I am pretty upset that the first surgeon didn't do the 4 corner surgery as it should have been done and now, after going through all of the pain from the surgery and the continued pain for about 10 months, I have to have it done all over again. If there are any of you that have had a total wrist fusion, I would be interesting in knowing information about it.
Thanks!!

 

[Jaycey]

@rdgallo So sorry your fusion was not successful. It's strange that the surgeon did not use any hardware. But it sounds like your new surgeon is a bit more knowledgeable.

I can't recall any of our members who have had this procedure. But your thread title should attract anyone here with experience.

 

[rdgallo]

The new surgeon says he will use multiple pins (k wires..minimum of 6), and they will all be internal and need taken out after 3 months. The other surgeon used only one and it was sticking out through the skin on the back of my hand (photo attached). It got a bit infected, so he took it out after 5 weeks and told me everything was fusing correctly. I asked him why he only used one K wire and he said he found that was all that was necessary. Anyway, I will report back after my revision surgery.

 

[Marvy]

Hi @rdgallo - Unfortunately, I cannot give you any advice on the fusion surgery.

However, I am facing this surgery on my right hand (I'm left handed). It really started when I was working out in the yard and felt a "pop" in my wrist/hand. The pain has gotten worse.

I went to see a hand specialist and his advice was "lets keep doing cortisone shots until they don't work, then we will do a proximal row carpectomy." I have no cartilage left in between the bones in my hand.

I saw another hand specialist in a different practice and he said I needed the 4 corner fusion. His exact words were "do not let anyone convince you to do a Proximal Row Carpectomy (PRC) as you are not a candidate for that because of the lack of cartilage" I never told him that doctor #1 recommended a PRC.

I'm now going to get a 3rd opinion next Friday.

My concerns are that I won't be able to do much after surgery - even though doc #2 said most patients get back to tennis, gardening, etc. I asked about lifting weights (nothing crazy heavy) and he just said for me to remember I am not 20 anymore. (my pet peeve is when they attach a label to you only because of your age). I truly don't know what to do. Doctor #2 did say that the surgery wasn't urgent and that I could come back in a year or more and he'd still do the 4 corner fusion...

Sorry to hijack your thread.

I wish you the best with your upcoming revision surgery...

 

[rdgallo]

Hi, Marvy. Sorry to hear about your issues with your wrist. I believe your doctor #2 is telling you the correct info. From what I have read, the PRC surgery relies on you having some cartilage on some of the carpal bones (I don't remember for sure which ones). If you have the PRC and do not meet this criteria, you are setting yourself up for more arthritis in the joint with the remaining carpal bones (if I remember correctly).

It is my understanding that the four corner fusion does cut down on your range of motion in the wrist, but still leaves some, whereas the total fusion locks the wrist in one position. I was a good candidate for the four corner fusion as I still had some cartilage on the Lunate carpal bone.

Unfortunately, the doctor that did my four corner fusion didn't come close to doing it correctly. As I mentioned in an earlier post, the new surgeon will be doing a revision four corner fusion surgery on Dec 8. If what he thinks are cysts (that showed up on the CT scan) prevent the possibility of a successful four corner surgery, he will be doing a complete wrist fusion using a DePuy Synthes plate. He said he won't know for sure until he is into my wrist during the surgery.

Prior to the failed surgery in January, I was gettting corisone injections in both wrists for about 2 years. These injections helped a lot for about 2-3 months at a time. I still get them in my right wrist.

I also had a denervation surgery on the right wrist which helped with the pain quite a bit. There is nothing wrong with a third opinion, but I think doc #2 is "spot" on.

I hope things go well for you, Marvy. I will try to remember to update this post after my Dec 8 surgery. Thanks for sharing your info with us.

 

[Peppertess100]

I had a four corner fusion on my left wrist approx 20 years ago after a scaphoid non union. My surgeon used a spider plate which was a new technique back then and had to order everything from America as it wasn’t used in the UK.

I will start from the beginning, I broke my wrist in early 1997 when I was 16 after going to the hospital they said I had broke my scaphoid - cue a cast for 6 weeks. 6 weeks later there was no joy in it healing so they arranged for me to have my scaphoid surgically repaired using a Herbert screw technique however due to me having my school exams in the June and I am left handed I opted to not have the operation until after my exams.
My operation to fix my scaphoid was in the July of 1997, all went well and 6 weeks later my plaster cast came off and I start pyshio, in the later part of 1997 I then had a follow up appt with my surgeon - at this point my wrist was still fairly painful so I told the surgeon this - my surgeon was horrible to me and basically shouted at me saying it shouldn’tbe hurting now - I was a naive 16 year old so I believed the surgeon and didn’t say any more about the pain.
Fast forward a couple more years, my wrist was still really painful so I went back fo the doctor to be referred back to the hospital - my original surgeon had now retired so I saw a new surgeon who was lovely and listened to everything - after having X-rays and checking my wrist over he told me that my scaphoid had not fixed and that the bone had died and there were cysts growing on it - he then gave me 2 choices
1) we leave it and do nothing
2) a four corner fusion

now the four corner fusion was an operation that they rarely did on someone of my age - I was around 18 however as it was my dominant hand and it was so painful if seemed the obvious choice.

My four corner fusion was completed using a spider plate and they used a bone graft from my hip, after being put in a half cast I was allowed home tostart the recovery process - 8 weeks later my final cast came off - it hurt and the physio was hard but it helped.
I have good movement when I flex my hand forwards, I have slight movement when I flex my hand side to side but I have virtually no movement to flex my hand backwards, I had one complication where one of the screws they used was too long and was digging in one of the other bones in my wrist so I had to have that removed but other than that I’ve had no other issues.
I do now had arthritis in my wrist and during the cold periods it is painful but the pain is manageable and was something I was expecting eventually.
I’ve attached some photos to try and show the movement I have.

Helen