Wrist fusion versus limited carpal fusion in advanced kienbock's disease

Abstract

We treated 18 patients with advanced Kienbock's disease surgically. Six had total wrist fusions and 12 had limited carpal fusions. The average age was 39.6 yrs and the average follow up was 61.8 months and 66.8 months respectively. The visual analogue pain scores, the patient satisfaction scores and the SF 12 were better in the total wrist fusion group. The DASH (Disabilities of the Arm, Shoulder and Hand) scores, the range of movement and the grip strengths were better in the limited carpal fusions group but this was not statistically significant. Four patients with limited carpal fusions had a non-union that required revising. We believe that total wrist fusion should be offered earlier to patients with advanced stages of the disease, as there are less surgical failures, more satisfied patients, better post operative pain scores and consistent long-term results with less potential for further deterioration with time as compared to other treatment methods.Résumé Nous avons traité chirurgicalement 18 malades avec une maladie de Kienbock avancée. Six malades ont eu une arthrodèse radio-carpienne complète et 12 une arthrodèse carpienne limitée. L'âge moyen était de 39,6 ans et la moyenne de suivi était de 61,8 mois et 66,8 mois respectivement. La score analogique visuel de la douleur, la score de satisfaction des malades et le score SF 12 sont meilleurs dans le groupe fusion complète. Le score DASH (Invalidités Bras, Épaule et Main), l'amplitude de mouvement et la force de préhension étaient meilleurs dans le groupe des fusions carpiennes limitées mais ce n'était pas statistiquement significatif. Quatre malades avec une fusion carpienne limitée avaient une pseudarthrose qui a exigé une révision. Nous croyons que la fusion complète du poignet devrait être offerte plus précocement aux malades aux étapes avancées de la maladie, car il y aurait moins d'échec chirurgicaux, plus de patients satisfaits, de meilleurs résultats sur la douleur, et des résultats plus solides à long terme avec moins de risque de détérioration secondaire, comparée aux autres méthodes du traitement.

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

“…On the other hand, Tambe et al retrospectively compared 18 patients with Lichtman stages IIIB and IV who were treated with total versus limited wrist fusions. 25 The authors stated that, although pain after total wrist fusion was significantly improved compared with limited fusions, the improvement of grip strengths and the DASH scores was slightly better in the limited fusion group which has no statistical significance. As expected, the partial wrist fusion group retained some movement while the total wrist fusion group had none.…”

Vascularized medial femoral condyle graft for nonunion after failed radiolunate arthrodesis

“…Radiolunate arthrodesis, as reported by Chamay et al, is an effective procedure to relieve pain and retain some flexion/extension for treatment of degenerative radiolunate arthritis due to rheumatoid arthritis and distal radius fracture [4,5]. One disadvantage of radiolunate arthrodesis is non-union [6,7]. However, Ono reported good outcomes of radiolunate fusion using a vascularized radius graft for treatment of Bain's grade 2A Kienb€ ock disease with incongruity of the radiolunate joint [8].…”

Kienböck's Disease

“…31 Tambe and colleagues compared outcomes of patients treated with partial intercarpal arthrodesis and radiocarpal arthrodesis for advanced Kienböck's disease, and they found that patients treated with radiocarpal arthrodesis had improved outcomes at latest follow-up. 32 Proximal row carpectomy (PRC) is a successful salvage procedure, but the capitate head must be largely free of degenerative changes. If mild arthritic changes are present on the capitate head, an interpositional arthroplasty of dorsal wrist capsule in addition to the PRC can be effective.…”