Surgical Treatment in Stage III Kienböck's Disease

Abstract

Kienböck's disease is aseptic necrosis of lunatum. It is the most common aseptic necrosis in the carpal region. Since 1910, when Kienböck published his classic description of lunatomalacia neither the etiology, nor a reliable treatment for this condition has been established with certainly. In this study 8 patients who were classified stage III Kienböck's disease according to Lichtmann classification system were evaluated and late results were discussed. Chronic wrist pain was the cause of hospitalization of all cases. All patients and their x-rays were examined and had been diagnosed as stage III according to Lichtmann. Then surgical treatment was selected. Five cases had negative ulnar variance and 3 cases had normal ulnar variance. Mean age was 30.3 (20-56). Male/female ratio was 3/5. Six dominant hand and 2 nondominant hand had been illed. Twenty-five percent of cases had heavy work. Soft tissue arthroplasty combined excision of lunatum were done to 3 cases. Intercarpal arthrodesis without excision of lunatum were done to 3 cases. Only one radial shortening was performed. And lunatum excision with anchuesis of tendon allograft combined scaphocapitate fusion was performed to one patient. Later on wrist arthrodesis have performed to a patient who was in second group because of progressing of its disease to stage 1V. Postoperative mean follow-up period was 7 years (1-15 year). The patients were evaluated according to pain, carpal collapse, instability, range of motion, grip strength and osteoarthritic changes. And the results were discussed.