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Scapho-capitate fusion This is a procedure that can be stage 3 or 4 of Keinböcks disease (avascular necrosis of the lunate bone which means the lunate bone dies because of a lack of blood supply). It occurs spontaneously and no-one really knows what causes it. It tends to occur in young people. ANAESTHETIC General or regional anaesthetic. OPERATIVE PROCEDURE A 6cm long incision is made over the back of the wrist. The extensor tendons are identified and retracted so damage to them is avoided. The wrist joint itself is exposed and the lunate bone is identified and removed. The joint surfaces between the scaphoid bone and the capitate bone are removed using a dental burr (horrid sounding drill that dentist's use!). A bone graft is taken from the end of the distal radius through a window in the back of the bone. The bone graft is then placed into the gap between the scaphoid and the capitate and a screw passed between the two bones usually a self burying screw of Herbert type which gives compression between the scaphoid and the capitate and squeezes the bone graft in the gap. Joint capsule is closed and the sub-cutaneous tissues are closed in layers and the skin is closed with nylon sutures. POST OPERATIVELY Plaster of Paris half splint is applied (this allows swelling). The patients is elevated in a high arm sling and sent home. They will be discharged the same day or the following day. The half splint is maintained for two weeks. The patient is seen in a clinic at two weeks and the splint is remove and the sutures are removed. A formal plaster cast is applied for a further four weeks. The patient is then seen and X-rayed and if the bones have joined in that time then the plaster is removed and mobilised. If the bones haven't joined there may be plaster immobilisation for a further 6 weeks. COMPLICATIONS
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