J Korean Orthop Assoc.  2010 Aug;45(4):249-255.

Limited Wrist Fusion for Kienbock's Disease

• Lee SM
• Song SW
• Rhee SK
• Park JC
• Na KT

Abstract

PURPOSE
To evaluate clinical outcomes of triscaphe (STT), scapho-capitate (SC) and scapho-capito-hamato-triquetral (SCHT) fusion in advanced Kienbock's disease. MATERIALS AND
METHODS
Forty patients with Lichtman stage III and IV disease were treated with limited wrist fusion. STT & SC fusion for stage IIIa and IIIb, and SCHT fusion for IIIb and IV were done according to preoperative radiologic and intraoperative articular surface findings. The mean follow-up period was 31.6 months (range 13-108) and the mean age at the time of their surgery was 44.7 years (range 22-71). There were 13 cases of STT fusion, 19 cases of SC fusion and 8 cases of SCHT fusion. For assessment of treatment results, wrist range of motion, grip strength, VAS (visual analog pain score) and any radiologic changes of the wrist were checked at last follow-up.
RESULTS
VAS score was 4.7 for STT, 3.0 for SC, 4.5 for SCHT. Grip strength, compared with the contralateral side, was 72% for STT, 78% for SC, and 54% for SCHT. Pain was more improved for the SC fusion group than for the other two groups (p=0.007). Grip strength was decreased more in the SCHT fusion group than in the other two groups (p=0.009). There were no statistically significant differences in range of motion between any of the three groups. The bone achieved union in all cases except one SC fusion.
CONCLUSION
Limited wrist fusion in advanced Kienbock's disease has been regarded as a valuable method. However, SC fusion has been thought of as a more favorable technique than STT fusion with respect to pain relief. SCHT fusion is thought to be a possible salvage procedure with a limited indication for Stage IV Kienbock's disease.

Keyword

Kienbock's disease; limited wrist fusion

MeSH Terms

Follow-Up Studies
Hand Strength
Humans
Osteonecrosis
Range of Motion, Articular
Wrist

Figure

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  Figure 1 (A) Schematic image of the scapho-capito-hamato-triquetral fusion. (B) Scapholunate angle is about 45 degrees.

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  Figure 2 A 36-year-old woman with Kienböck's disease. (A, B) Preoperative plain radiographs show collapsed lunate, but scapholunate angle is within normal range (Lichtman IIIa). (C) Magnetic resonance image shows avascular necrosis of the lunate. (D, E) Postoperative plain radiographs. (F) Twenty five months after scapho-capitate fusion, patient was relieved from the wrist pain and preserved some wrist motions.

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  Figure 3 A 50-year-old man with Kienböck's disease. (A, B) Preoperative plain radiograph shows carpal collapse, lunate fragmentation and scaphoid rotational deformity. (C) Magnetic resonance image shows midcarpal joint arthritic change. (D, E) Postoperative plain radiographs. (F) Sixteen months after the scapho-capito-hamato-triquetral fusion, patient was improved from pain, and still preserved some radiocarpal joint motions.

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