Get Off My Porch and Get To Work!: One More Time!

One More Time!

So, hopefully the final solution to my wrist pain was one more surgery on the radial side of my arm/wrist. After several MRIs, X-Rays, differing opinions, the final decision was to do an wrist arthroscopy on the radial side of the wrist.

October 3rd, my surgeon's plan was to do the arthroscopy to look at the ligaments that connect the Scaphoid-Lunate-Radius. MRIs showed that there may be a tear- just not clear enough to determine a way-forward. Bottom line- if going untreated- would lead to advanced arthritis and possible significant bone-on-bone problems. If the ligaments are completely torn, they would have to be replaced with synthetic fiber grafts that would replace the torn ligament. Unfortunately, ligaments do not repair after a few weeks of initial injury- as they do not have enough blood flow to promote organic healing.

Arthroscopy: The Scaphoid Bone on left, and Lunate on the Right. The probe in between the two bones- which should not happen! There should be a smooth connecting ligament connecting the two bones together, but the Scapho-Lunate Ligament (SLL) is completely torn and the two bones moving independently.

NEXT STEPS

The doc realized that the ligament was completely torn, along with the signs of early arthritis and significant cartilage loss. She then moved into an open repair/reduction and internal fixation of the SL Joint. Below are the two images where she placed large wires in each of the bones, and maneuvered them link 'Joysticks' until she got them anatomically aligned. She then placed two more wires to hold that position until she could 'internally and permanently' fix them in position

Original position showing the left and right wires in the original position- notice they are straight. The large upside-down U is a spreader keeping the joint exposed, the clamp on the right, and the top of the plate with screws on the ulna.

Here , notice the two wires are now significantly bent to align the Scaphoid and Lunate bones.

Once she had the proper alignment, she used a synthetic graft that is woven with a partial graft from a tendon in my wrist. There are four screws that hold the different ends of the grafts in the bones (Internal Fixation) which will keep the bones in alignment and (hopefully) prevent further deterioration of the cartilage among the Scaphoid-Lunate-Radius bones.

Above shows the final outcome. Since the screws and ligaments are not metallic, they do not show up on X-Rays. The RED dots are the bone screws where the new synthetic-organic grafts are anchored. The YELLOW is the one long graft that is woven around the anchors. The pattern follows the same route as the original ligaments that were torn. You can also see the Ulnar Plate at the the bottom of the picture.

So, Here We Are!

I was in a long-arm post-op splint for a few days, then into an arm cast for eight weeks. Got that cast on on December 3rd, which was a day of celebration! I could finally shower without a bag over my arm! However the pain and stiffness was extremely painful, but expected.