Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

Abstract

<p class="abstract"><strong>Background:</strong> Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment option for stage III Kienbock’s disease.</p><p class="abstract"><strong>Methods:</strong> This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a lawyer. The average follow up period was 14.2 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5. Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90 mmHg representing 93.2% of the contralateral side.</p><p><strong>Conclusions:</strong> Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion.</p>

Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis

“…Eight studies evaluated postoperative radial deviation. 11 , 13 , 14 , 20 , 22 , 23 , 24 , 25 Overall, there was a significant reduction in radial deviation after surgery ( Fig. 3 ; WMD, −2.3; 95% CI, −4.3 to 0.3; P v =.03) with significant heterogeneity (I 2 = 73%; P =.00).…”

“…Eight studies compared the preoperative and postoperative ulnar deviation. 11 , 13 , 14 , 20 , 22 , 23 , 24 , 25 Overall, there was no significant difference in ulnar deviation after the surgery ( Fig. 3 ; WMD, −1.6; 95% CI, −4.93 to 1.66; P value = NS), but heterogeneity was significant (I 2 = 77%; P =.00).…”

“…Moreover, two studies evaluated the modified Mayo score. 15 , 24 Overall, the mean postoperative modified Mayo score was 59.9 ( Fig. 5 ; 95% CI, 18.7–101.0), and heterogeneity was significant (I 2 = 87%; P =.01).…”

“…Nine studies evaluated the postoperative wrist flexion ROM 11 , 13 , 14 , 20 , 21 , 22 , 23 , 24 , 25 ; there was no significant difference before and after surgery ( Fig. 3 ; WMD, 1.3; 95% CI, −3.0 to 5.5, P = NS), but the heterogeneity was significant (I 2 = 82%; P value =.00).…”

“…Three studies evaluated the grip strength in mm Hg after surgery. 20 , 24 , 25 Overall, there was a significant increase in postoperative grip strength (preoperative: mean, 155.6; 95% CI, 49.1–262.0; postoperative: mean, 180.5; 95% CI, 93.6–267.5) ( Fig. 4 ; WMD, 13.3; 95% CI, 3.2–23.4; P value =.00) and heterogeneity was significant (I 2 = 95%; P =.00).…”