J Korean Soc Surg Hand.  2015 Sep;20(3):110-118. 10.12790/jkssh.2015.20.3.110.

Lunate Excision and Tendon Ball Implantation in Lichtman Stage IIIB Kienbock's Disease in Middle-Aged Patients

• Cheon SJ
• Lee DH
• Park SH
• Jeon WK

• KMID: 2068816
• DOI: http://doi.org/10.12790/jkssh.2015.20.3.110

Abstract

PURPOSE
Our purpose was to assess the results of lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbockos disease in middle-aged patients.
METHODS
Ten patients with Lichtman stage IIIB Kienbock's disease who underwent lunate excision and tendon ball implantation and followed up at least 24 months were analyzed. There were 4 males and 6 females. The mean age at the time of surgery was 55.4 years (range, 48-67 years), and follow-up period ranged from 24 to 68 months (mean, 46 months). Radiocarpal joint pain, grip strength, return to daily living activity, range of motion were evaluated and radiologic findings of preoperative, postoperative and last follow-up were evaluated.
RESULTS
All patients returned to daily living activity after 6 months of surgery. At the last follow up, 8 patients had no pain and 2 patients experienced mild pain occasionally. The mean improvement of extension arc was 14.5degrees, and the mean flexion arc improved 8.5degrees. The mean grip strength was 88% of unaffected side. The mean carpal height ratio was 0.49 preoperatively, 0.47 at final follow-up. No patients showed osteoarthritis change at the last follow-up. The mean Cooney's wrist function were 83, 4 patients had excellent, 4 had good, and 2 had fair.
CONCLUSION
Lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbock's disease in middle-aged patients showed satisfactory clinical, functional and radiological results. So this can be a reasonable treatment option.

Keyword

Kienbock's disease; Lunate; Avascular necrosis; Tendon ball implantation

MeSH Terms

Activities of Daily Living
Arthralgia
Female
Follow-Up Studies
Hand Strength
Humans
Male
Osteoarthritis
Osteonecrosis*
Range of Motion, Articular
Tendons*
Wrist

Figure

• 

  Fig. 1. A 66-year-old female with Lichtman Class IIIB Kienbock’s disease. Third, fourth extensor compartment were found (A) and retracted to ulnar side (B). Tendon ball was made of Palmaris longus and plantaris tendons (C). After curettage of necrotic lunate bone tendon ball was inserted (D).

• 

  Fig. 2. (A) Preoperative radiograph shows necrotic collapse of right lunate, Lichtman Class IIIB Kienbock’s disease. (B) Immediate postoperative radiograph shows excision of lunate, tendon transposition, temporary scaphocapitate fixation and thumb spica cast application. (C) 8 weeks postoperatively showing removal of K-wire and no residual bony fragment. (D) 45 months after surgery showing no further collapse or osteoarthritic change with calcification.

• 

  Fig. 3. A 55-year-old male with Lichtman Class IIIB Kienbock’s disease (case No. 8). (A, B) Preoperative radiograph shows necrotic collapse of left lunate and ulnar negative varience. (C, D) 37 months after surgery showing no further collapse or osteoarthritic change with calcificaion.

Reference

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