Lunatum excision and scaphocapitate arthrodesis in Kienböck's disease.

Abstract

The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman's stage IIIB Kienböck's disease. The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18-54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. The mean follow-up period was 17.33 ± 4.69 months (range: 12-24 months), mean operation time was 56.67 ± 12.5 min (range: 45-75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2-6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28-37%) and mean VAS score was 7.6 (range: 7-8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63-81%) and mean VAS score was recorded as 1.4 (range: 1-2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.