Seeking Solutions for Left Wrist Dislocation and Avascular Necrosis

Hello Professor Shi, I have an issue with a dislocated left wrist and avascular necrosis of the scaphoid bone?

I was very happy to see you at National Taiwan University Hospital on the afternoon of March 10th, but I have many questions about how to treat and manage my left hand.
1.
Can I take a tendon to stabilize the joint, or should I use a plate to fix the dislocated ulna (which has been shortened by about 2 cm)? I have been in pain for 4 months, primarily feeling the pain from the dislocated ulna.
Dr.
Sun Ruisheng mentioned that further surgery may not improve the situation, and Dr.
Zhang Zhihao did not assist me and instead canceled my appointment.
I was in tears in Dr.
Zhang's office, feeling pain and despair, but my condition is really serious.
Four years ago, I injured myself while rescuing a stray dog, leading to ulnar impaction syndrome.
I truly hope to improve my condition through surgery to alleviate the pain from the dislocated ulna, as I also have arthritis.
I sincerely hope you can help me or refer me to a hand surgeon at your hospital or elsewhere in Taiwan.
My medical record number is 3569149.
I am extremely grateful.
Thank you, doctor.

Shu Wei, 20~29 year old female. Ask Date: 2017/03/11

Dr. Shi Guozheng reply Orthopedics

The advice from the hand surgeons at National Taiwan University can be trusted.
If you still have doubts, you can consult the hand surgery department at other medical centers, such as Linkou Chang Gung Memorial Hospital, Taipei Veterans General Hospital, or other medical institutions.

Reply Date: 2017/03/11

More Info

It sounds like you are experiencing significant pain and dysfunction in your left wrist due to a dislocation and possibly avascular necrosis (AVN) following an injury. Given the complexity of your situation, it's essential to approach this with a comprehensive understanding of your condition and the available treatment options.

Firstly, it's important to clarify the nature of your injury. A wrist dislocation, particularly involving the ulnar bone (the ulna), can lead to various complications, including chronic pain, instability, and, as you mentioned, avascular necrosis. AVN occurs when the blood supply to a bone is disrupted, leading to bone death and potential collapse. This condition can be particularly challenging to treat, especially in weight-bearing joints or those that are crucial for daily activities, such as the wrist.

In terms of treatment options, surgical intervention is often considered when conservative measures (like physical therapy, splinting, or medication) fail to provide relief. Here are some potential surgical options you might discuss with your orthopedic surgeon:
1. Tendon Grafting or Reconstruction: If the ligaments or tendons around the wrist are damaged, a tendon graft may be used to stabilize the joint. This procedure can help restore function and alleviate pain.

2. Internal Fixation: Using plates or screws to stabilize the dislocated bones can be effective. This method allows for proper alignment and healing of the wrist joint.

3. Ulnar Shortening Osteotomy: If the ulna is too long and causing impingement or pain, shortening the ulna can relieve pressure on the wrist joint and improve symptoms.

4. Arthroscopy: This minimally invasive procedure allows the surgeon to visualize the joint and address any loose bodies, damaged cartilage, or other issues contributing to your pain.

5. Bone Grafting: If AVN is present, a bone graft may be necessary to restore blood flow and support healing. This can involve taking bone from another part of your body or using synthetic materials.

6. Joint Replacement: In severe cases where the joint is significantly damaged, a partial or total wrist replacement may be considered.

It's crucial to have a thorough discussion with your orthopedic surgeon about the risks and benefits of each procedure, especially considering your history of pain and the impact on your quality of life. If you feel that your current doctors are not addressing your concerns adequately, seeking a second opinion from another orthopedic specialist, particularly one who specializes in wrist injuries, may provide you with additional insights and options.

In addition to surgical options, consider discussing pain management strategies, including physical therapy, occupational therapy, and possibly pain medications or injections to help manage your symptoms while you explore surgical solutions.

Lastly, it's essential to maintain open communication with your healthcare providers. Express your concerns, the impact of your symptoms on your daily life, and your desire for a timely resolution. This will help ensure that you receive the appropriate care and support as you navigate this challenging situation.

In summary, while your condition is complex, there are various surgical options available that could potentially improve your symptoms and restore function to your wrist. Engaging in a thorough discussion with an orthopedic specialist will be key in determining the best course of action for your specific situation.

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