Biomechanical analysis of load transmission characteristics of limited carpal fusions used to treat Kienböck's disease

Abstract

Although limited carpal fusions used in the treatment of Kienböck's disease are thought to act by decreasing the loads on the lunate, biomechanical studies show that capitohamate fusion acts oppositely to what is expected. This experimental study was designed to resolve this paradox. In a biomechanical cadaveric study, load transmissions at the radioulnacarpal joint were investigated under 140 and 210 newtons of load with three wrist postures, namely, neutral, ulnar and radial deviations, in five intact wrists and after scaphotrapeziotrapezoid, capitohamate, and scaphocapitate fusions. Under 140 newtons of load, the loads imposed to the lunate decreased following scaphotrapeziotrapezoid and scaphocapitate fusions, but increased after capitohamate fusion. However, when the load was increased to 210 newtons, there were no differences between intact wrists and limited carpal fusions in respect to the loads exerted on the lunate. In all the situations, the lunate was subjected to a significantly greater load in ulnar deviation. These results suggest that limited carpal fusions do not alter load transmission characteristics of the wrist joint under 210 newtons of load. The etiology of the Kienböck's disease seems to be related to an overload in ulnar deviation and the beneficial effect of limited carpal fusions seems to be associated with restricted ulnar deviation of the wrist rather than load transmission characteristics.