Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienböck's disease

Abstract

ObjectiveThe aim of this study was to report our results of lunate excision combined with capitohamate fusion in the treatment of Kienböck's stage IIIB/IIIC disease.MethodsA total of 7 patients with a mean age 35.2 (SD 11.5) years were enrolled in the study. Pain was the principal reason for surgery. All operations were carried out by the same senior surgeon. Patients were evaluated in terms of range of motion, DASH and VAS scores, satisfaction, and grip/tip/palmar/key pinch strength compared with contralateral sides. Preoperative carpal height indexes and findings of osteoarthritis were determined radiographically and compared with postoperative evaluations.ResultsMean duration of follow up was 15.2 months. Mean DASH and VAS scores were 13.8 2.7 and 2 1.1 respectively. The mean patient satisfaction score was 3.2 0.4 over 4 points. The mean grip strength in the operated hands was 66.4%, palmar pinch was 75.1%, tip pinch was 71.8% and key pinch was 70.4% when compared to the contralateral unaffected sides. The mean flexion range in the operated hands was 58.8%, extension range was 60.3%, radial deviation range was 65.2% and ulnar deviation range was 65.7% when compared to the contralateral sides. There was no significant difference between preoperative and postoperative carpal height ratios (p = 0.086).ConclusionsOur early term results indicate that lunate excision combined with capitohamate fusion may be an alternative treatment option in patients with stage IIIB and IIIC Kienböck's disease.Level of EvidenceLevel IV, Therapeutic study.

Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

“…Поэтому в таких случаях часто выполняются частичные артродезы костей запястья (STT или SС) с удалением полулунной кости или без такового, эндопротезирование полулунной кости, удаление проксимального ряда костей запястья или тотальный артродез кистевого сустава. Несмотря на хорошие исходы лечения после удаления проксимального ряда костей запястья, данная операция значительно нарушает биомеханику кистевого сустава и обычно рассматривается в качестве последней попытки сохранить функцию кистевого сустава перед его тотальным артродезом [6,11,15,22]. L. Innes и R.J. Strauch провели исследование исходов лечения болезни Кинбека, основываясь на публикациях ресурсов PubMed, Medline и Cochrane за 1998-2008 гг.…”

“…Разработано множество способов лечения указанного заболевания, ни один из которых не позволяет добиться стабильно хороших результатов [6]. С этой целью выполняются различные варианты костной пластики кровоснабжаемыми и некровоснабжаемыми трансплантатами, пересаживаемыми как в свободном, так и в несвободном варианте, в том числе с использованием стволовых мезенхимальных клеток, остеотомий лучевой и головчатой костей, частичного или тотального артродеза кистевого сустава, его эндопротезирования либо пластики полулунной кости костным цементом [6,7,8,9,10,11,12,13,14,15,16,17,18]. Во многом тактика оперативного лечения основана на рентгенологической картине изменений самой полулунной кости и близлежащих костей кистевого сустава.…”

Kienbock’s disease-avascular necrosis of lunate operated with excisional arthroplasty and Palmaris longus graft interposition

“…However, filling the void with a coiled tendon after excision of the lunate is recommended to prevent carpal collapse. Silicone replacement arthroplasty vascularised pisiform transposition and coiled tendon grafts are current methods of filling the void [4] . Coiled tendon grafts are currently the procedure of choice and Palmaris longus tendon is preferred as the graft can be harvested through the same limb.…”

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…36 Chronic and degenerative pathologies treated with lunate excision include Kienbock's disease, isolated radiolunate arthritis, and chronic lunate dislocation. Management of stage IIIB and IV Kienbock's disease revolves around lunate excision combined with additional carpal stabilization procedures: STT arthrodesis, 37 SCA, [38][39][40] capitohamate arthrodesis, 41 vascularized bone grafting, [42][43][44] and distraction osteogenesis. [45][46][47] Lunate excision alone has potential in specific, low-demand patients knowing that loss of carpal height will occur.…”