DarkerBlue - Andrea's Story and Images

Andrea's Unsuccessful Radial Wedge Osteotomy and Ensuing Lunate Decompression Failure

My only recollection of falling on a flat hand was around November 2008. I had gone for a walk on the beach and there were kids from the local school having a beach day there. The kids were all getting into mini buses while I was walking back towards the car park. In front of me was a low chain across the entrance and I somehow caught my foot on it and went flying…… much to the kids amusement!
In December that year we had to move house and the day before the move I had a sharp pain in my hand next to the thumb, I was conscious of it all day but I thought it would resolve spontaneously, my aches and pains usually did. The move went ahead. My husband and I moved everything ourselves with no help, and by the end of the day my hand was very painful and very swollen. The next day I phoned in work sick as I couldn’t drive my car, however it was better than the day before and was better again the next day so I went back to work. The pain in my hand settled down but it never went away completely.
I took a new job in the following March which really put stress on my wrist. According to my husband, I moaned about the pain all the time. It felt like a bad sprain. By July I was beginning to think that I should get it checked out. I asked my husband to ask an Orthopaedic surgeon that he was working with, what could be wrong. The surgeon said I should get an X-ray done which probably would not show anything, but he thought I could possibly have an old scaphoid fracture. Based on what the surgeon said I did not rush out and get the X-ray, but I did get it done the day before my husband was due to work with him again.

Andrea's original diagnostic x-rays

The report said the X-ray was highly suggestive of Kienbock's disease, I immediately sent a text message to my husband, “I have got Kienbock's disease, what the hell is that?" The next day my surgeon looked at the films and confirmed the Kienbock's without looking at the report and told my husband to tell me to come and see him as soon as I could.
That was the start of my Kienbock's roller coaster ride. I was told to wear a wrist brace until my first surgery, which was booked for September 2009, a wedge radial osteotomy with application of an Accumed volar plate. This was chosen due to my neutral ulnar variance. My husband assisted with the surgery and the whole two hours were filmed on DVD. I had a pain buster pump put in, which was fantastic, and I stayed overnight in hospital following the operation. After a few days the bandages were removed. I did not have a cast or brace, and I started mobilizing my wrist straight away.
X-ray showing Andrea's wrist six weeks after her radial wedge ostotomy

At three weeks the scar started to hypertrophy and looked really ugly by six weeks. The six week X-ray showed slight loss of height of the lunate bone, but otherwise the osteotomy was healing well. ROM was still limited but was improving. Just after the six week check up I noticed a lump on the top of my wrist about a third of the way up my arm and I could feel crepitations when I moved my wrist up and down.

One and a half weeks after Andrea's radial wedge osteotomy (left) and the incision at twelve weeks post-surgery (right)

My second post-op X-ray was at 13 weeks, the lunate appeared no worse but the scar was still pulling and it remained ugly even though I had been putting a silicone scar dressing on daily. My surgeon suggested that the scar was caused by the stitches and my skin elasticity. It was agreed that I should have the plate removed due to the lump on top of my wrist and the crepitations which were quite pronounced, which could have been caused by irritation of the tendons by the screw tips. This was the last thing I expected to hear, as the pain was getting better, but the ROM had reduced. It actually felt like something in my wrist was preventing it from going forward and backwards (mostly forward).

Somewhere between my first and second post-op check-up, I had been at work and taken a patient over to the X-ray department. I can’t remember what caused it but something I did caused a sharp pain. The radiologist asked what was wrong with my wrist. "Oh," she said, "one of the girls who works here has that.” Naturally, I was keen to talk to her. I went looking for her and we exchanged Kienbock stories. She had a lump on top of her wrist exactly like mine, with crepitations exactly like mine, even though she had her surgery three years previously. She had been advised to have her plate out too.
I booked the operation for February, 2010. Plate removal and revision of the scar. During the time between my check up and the operation date, I did a lot of research into the Yahoo! lunate core decompression surgery that I read about on the Yahoo! Kienbock Disease Support Group. I emailed Doctors in the UK and Australia and spoke to my surgeon about it, and he agreed it would be worth trying when I had the plate removed.
My husband assisted again and the op took two hours, during the procedure it was found that there was a lot of tendon adhesions due to internal scar tissue. This was loosened and revised and a new tendon sheath was fashioned. A second incision was made on top of the wrist through which the lunate core decompression was performed. The wounds were closed using different sutures to try and prevent the scars from becoming hypertrophied again. I felt really positive, and had convinced myself that the lunate decompression was going to work!

This is the removed hardware that was used to secure Andrea's Radial Wedge Osteotomy

The lunate decompression procedure in progress

Post-op hardware removal/lunate decompression

Post operatively I was bandaged for the first few days and thereafter I was to wear my brace until my six week check up. Things went ok and at three weeks post-op I saw my surgeon when I took my mother for an appointment with him, he told me to take the brace off when I was at home and to gently mobilize. The pain did not settle and my ROM did not improve, actually the pain was worse but I just kept telling myself it was because I had incisions on both sides of my wrist. I also had a lump over the place where the lunate bone is situated, but again I thought this would settle as it was still early days.

The rather pronounced lump on Andrea's wrist

I had my six week X-ray and I could see straight away, on the lateral view, that the lunate appeared to be fractured right through the middle and the two halfs appeared to have seperated. When I saw my surgeon he said he thought it was fractured also but ordered a C T scan to confirm where the pieces of bone were. We discussed options and he seems to favour lunate replacement surgery, he said a PRC would make my wrist too weak.

X-ray six weeks after hardware removal/lunate decompression

I had the scan and gave it to my surgeon, he has been on leave for three weeks and I am now waiting for his feedback on it. I must say that I have been glad to not have any feedback up till now as I am scared to have more surgery, but I am also scared to leave it with the rate of progression. At this point in time I cannot do my job fully, I am doing admin which I really hate, my employer has said that I cannot do anything that will stress my wrist until I get a letter from my surgeon....I am still waiting with my head buried in the sand!

The final scan

May 28th, 2010

Comments, corrections, or suggestions related to these pages may be directed to DarkerBlue.

Comments or questions in any way concerning Kienbock's Disease are best directed to the Yahoo! Kienbock Disease Support Group.

My second post-op X-ray was at 13 weeks, the lunate appeared no worse but the scar was still pulling and it remained ugly even though I had been putting a silicone scar dressing on daily. My surgeon suggested that the scar was caused by the stitches and my skin elasticity. It was agreed that I should have the plate removed due to the lump on top of my wrist and the crepitations which were quite pronounced, which could have been caused by irritation of the tendons by the screw tips. This was the last thing I expected to hear, as the pain was getting better, but the ROM had reduced. It actually felt like something in my wrist was preventing it from going forward and backwards (mostly forward).
Somewhere between my first and second post-op check-up, I had been at work and taken a patient over to the X-ray department. I can’t remember what caused it but something I did caused a sharp pain. The radiologist asked what was wrong with my wrist. "Oh," she said, "one of the girls who works here has that.” Naturally, I was keen to talk to her. I went looking for her and we exchanged Kienbock stories. She had a lump on top of her wrist exactly like mine, with crepitations exactly like mine, even though she had her surgery three years previously. She had been advised to have her plate out too. I booked the operation for February, 2010. Plate removal and revision of the scar. During the time between my check up and the operation date, I did a lot of research into the Yahoo! lunate core decompression surgery that I read about on the Yahoo! Kienbock Disease Support Group. I emailed Doctors in the UK and Australia and spoke to my surgeon about it, and he agreed it would be worth trying when I had the plate removed. My husband assisted again and the op took two hours, during the procedure it was found that there was a lot of tendon adhesions due to internal scar tissue. This was loosened and revised and a new tendon sheath was fashioned. A second incision was made on top of the wrist through which the lunate core decompression was performed. The wounds were closed using different sutures to try and prevent the scars from becoming hypertrophied again. I felt really positive, and had convinced myself that the lunate decompression was going to work!

	*This is the removed hardware that was used to secure Andrea's Radial Wedge Osteotomy*

*The lunate decompression procedure in progress*

	*Post-op hardware removal/lunate decompression*

Post operatively I was bandaged for the first few days and thereafter I was to wear my brace until my six week check up. Things went ok and at three weeks post-op I saw my surgeon when I took my mother for an appointment with him, he told me to take the brace off when I was at home and to gently mobilize. The pain did not settle and my ROM did not improve, actually the pain was worse but I just kept telling myself it was because I had incisions on both sides of my wrist. I also had a lump over the place where the lunate bone is situated, but again I thought this would settle as it was still early days.

The rather pronounced lump on Andrea's wrist

I had my six week X-ray and I could see straight away, on the lateral view, that the lunate appeared to be fractured right through the middle and the two halfs appeared to have seperated. When I saw my surgeon he said he thought it was fractured also but ordered a C T scan to confirm where the pieces of bone were. We discussed options and he seems to favour lunate replacement surgery, he said a PRC would make my wrist too weak.

	*X-ray six weeks after hardware removal/lunate decompression*

I had the scan and gave it to my surgeon, he has been on leave for three weeks and I am now waiting for his feedback on it. I must say that I have been glad to not have any feedback up till now as I am scared to have more surgery, but I am also scared to leave it with the rate of progression. At this point in time I cannot do my job fully, I am doing admin which I really hate, my employer has said that I cannot do anything that will stress my wrist until I get a letter from my surgeon....I am still waiting with my head buried in the sand!

*The final scan*

*May 28th, 2010*