Scaphoidectomy

Richmcfinn

Hi I am wondering if anyone here has had one of these?
My surgeon removed the scaphoid bone and somehow looped half of a tendon through the gap. This is instead of a four corner fusion or a front row carpectomy and I am a bit worried that I can find info on both these procedures but nothing whatsoever about what Ive had done on the entire web!
Surgery was seven weeks ago now and I am healing well but with very little forward and backward motion in my wrist so far

stickywicket

Hello richmcfinn and welcome to the forum. I saw your other post on 'Say Hello' but thought I'd reply here.

I use this forum regularly and have done for some years but I've never heard of a scaphoidectomy. When I put the term into our search engine nothing came up. Nor did I fare any better on Arthritis Research UK, normally a very informative site. This suggests to me that it's quite a new operation.

This is a PubMed study of 40 'scaphoidectomy and four-corner fusion' patients http://tinyurl.com/zbabm7s . The conclusions seem good.

“This retrospective cohort study of patients followed up for more than 10 years showed that the midterm and long-term results of 4-corner fusion for stage III SLAC were satisfactory, and arthritic changes in the radiolunate joint were minimal.”

I hope you have equally good results. My wrists fused themselves over time and I don't recommend it

Richmcfinn

Thanks Stickywicket for your welcome and for the info with link.
All the stuff Ive found on the internet involving scaphoidectomy talks about combining it with fusion of the other wrist bones (scaphoidectomy with four corner fusion) or removing the other wrist bones next to it as well (front row carpectomy)
There is no mention of removing just the scaphoid alone. The surgeon said something about using a tendon to keep everything tied together
I think you are right -it must be a new procedure, and really I should have been told this. Then again if he had then I doubt I would have gone with it. If the worse comes to the worse then I will have to have the fusion but I'm hoping that by the time it goes bad again there will be better wrist options available.
Your wrists being fused sounds unpleasant -did you have an op to fuse them or have they seized up by themselves?

stickywicket

Yes, all the stuff I've read had the scaphoidectomy combined with the four corner fusion. I think both are relatively new procedures but the stats did look OK, didn't they?

It's true that new and improved ops etc come out all the time so, with luck, if things do, eventually, go pear shaped for you, some other option will be available. I'd just suggest (as a veteran of 3 new knees and two new hips) that you treat your wrist exactly as suggested. If there are things you shouldn't do with it then try not to do them. If continuing exercises are prescribed then do them. My replaced joints (One replaced knee is now 35 years old, a bit dodgy but still holding me up) have all been great but I do still put them through their paces. As for the wrists – they fused themselves. I got RA back in 1961 when there was no decent treatment for it and there were no good hand ops until about the '80s or '90s.

I wish you all the best with yours.

Richmcfinn

stickywicket wrote:

Yes, all the stuff I've read had the scaphoidectomy combined with the four corner fusion. I think both are relatively new procedures but the stats did look OK, didn't they?

It's true that new and improved ops etc come out all the time so, with luck, if things do, eventually, go pear shaped for you, some other option will be available. I'd just suggest (as a veteran of 3 new knees and two new hips) that you treat your wrist exactly as suggested. If there are things you shouldn't do with it then try not to do them. If continuing exercises are prescribed then do them. My replaced joints (One replaced knee is now 35 years old, a bit dodgy but still holding me up) have all been great but I do still put them through their paces. As for the wrists – they fused themselves. I got RA back in 1961 when there was no decent treatment for it and there were no good hand ops until about the '80s or '90s.

I wish you all the best with yours.

Thanks again for your advice and good wishes. I will certainly be taking care of my wrist and doing the exercises as you suggest. If this doesn't work I can still have a wrist fusion or much better still by the time this arrangement wears out wrist replacement technology will be much better, and I can have an op which gives complete movement.
You have certainly been through it with your RA -I'm not sure how I would cope with that if it happened to me. Then again we do cope because we have to I suppose
I wish you all the best also
-Richard

Richmcfinn

webmanager wrote:

Hi Richmcfinn
I got our wonderful Peter, our information manager on this post to do some research for you. I hope these two references to research papers will be helpful

http://www.ncbi.nlm.nih.gov/pubmed/11469838/

"J Hand Surg Br. 2001 Aug;26(4):352-4.
A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist).
Garcia-López A1, Perez-Ubeda MJ, Marco F, Molina M, López-Duran L.
Author information
Abstract
This study reports the outcome of 16 patients treated with a modified four-bone fusion for symptomatic stage II and III advanced carpal collapse. The technique is based on fusion of the capitate, lunate, hamate and triquetrum using an autogenous corticocancellous bone-graft fixed with screws. The void left behind after scaphoid excision was filled with an extensor carpi radialis longus anchovy. After an average follow up of 3 years; there were 13 excellent and three good outcomes. In every patient pain relief was achieved with preservation of joint motion and grip strength. All the patients were able to return to their previous activities and jobs. Radiographic evaluation showed bone fusion in all 16 patients with a slight decrease in carpal height but a well preserved radiolunate joint space. In conclusion, this technique provides immediate stable fixation and early mobilization and assures bone fusion.
Copyright 2001 The British Society for Surgery of the Hand.


extensor carpi radialis longus anchovy = muscle and that muscle has a tendon

also:

‘……Kienböck’s disease is a painful idiopathic disorder of the wrist ……….. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity.’

http://www.hindawi.com/journals/tswj/2013/416246/

So, using a tendon/muscle to fill a gap which is created when bones are removed seems to be an established surgical procedure".
Best Wishes
Sharon

Thanks for looking into this for me Sharon. I see the second link is all about experiments on cadavers -I wasn't thinking of an operation which was quite as final as that LOL! But joking aside it seems that what I have been given could be called a scaphoidectomy with tendon interposition.
After very much searching on the web I have found absolutely nothing about this specific operation -anything involving scaphoidectomy always involves fusion of the other bones. So I have to assume it is a very new procedure that I have received. Whats done is done so now I am going to do my physio, be patient hope for the best.
I will let this forum know how I get on so that other people who are offered this treatment will know something about it before they make their decision.
Best wishes
-Richard

stickywicket

This might not be at all relevant but, just in case.....

I know when I had my knee revision my consultant did some work on the tendons – I think to give me more flexibility - which I'm sure didn't happen when the original TKR went in. I don't know what he did but I mention it because it might be that, even though your op seems to be unusual, using tendons to improve flexibility(?) might not be unusual in other orthopaedic areas.

[Deleted User]

Hi Richard
yes sorry about the second link but as you sat there is very little out there on this procedure and the information looked useful. Please keep us updated as this kind of information is so valuable to other people too. As you say it looks like it is a new procedure might be worth asking your consultant or seeing if he has written any papers on the subject
Best Wishes
Sharon

barbara12

Sorry I cant help Richard but I see the other have given you some info..and welcome to this lovely forum form me..

Richmcfinn

Thankyou all for your advice and your good wishes.
My physio starts a week Tuesday. I have been doing some hand exercises that I found online and my fingers and thumb have got really good range of movement, albeit a bit weak and shaky so I am grateful for that. The wrist has only about 20 degrees movement though. Lets see what they have in store for me I will keep posting my news of recovery (or lack of) either here or on another thread -Richard