Distraction arthrodiastasis of the wrist joint for treatment of Kienböck disease

Abstract

Background Although described as early as 1910, the most appropriate treatment for Kienbock disease has not been established yet. Multiple treatment modalities are advocated to tackle this condition. Objective This study was conducted to evaluate the effectiveness of arthrodiastasis as a new treatment modality on the revascularization of the lunate bone in Kienbock disease. This proposal is based on the successful application of arthrodiastasis in Perthes disease. Methods Between 2007 and 2010, seven patients with Kienbock disease were operated upon and retrospectively reviewed. In all patients, ring fixator distraction was applied. Clinical examination of the patients was carried out by observing the range of movement of the wrist and grip strength. Radiological classification was made according to Lichtman and Degnan’s classification. All patients underwent an MRI before surgery and at the end of 2-year follow-up. Results Assessment of pain according to the visual analogue scale showed improvement from an average of 7.0 to an average of 3.57. Range of wrist motion showed an increase in all directions. All patients resumed a near normal life pattern with a satisfaction scale rating of an average of 3.71 on a 0–5 scale. No remarkable complications were observed, except for pin tract infection in two patients. Conclusion Distraction arthrodiastasis has been proven to be an effective treatment modality for patients in early stages of Kienbock disease. It is believed that this technique of arthrodiastasis will help the ischemic lunate to revascularize. Further large-scale studies are encouraged to evaluate and modify this treatment modality. The participants of the study were treated in accordance with standard ethical guidelines.