Scaphocapitate arthrodesis is a viable option in advanced Kienböck′s disease

Abstract

BackgroundKienböck's disease remains a difficult entity to treat. Until the etiology and natural history of the disease are understood, treatment will continue to be based on attempts to decrease load across the lunate or bring a blood supply to it. There is no single procedure that could be used to treat patients with advanced Kienböck's disease.AimThe aim of this study had multiple facets: first, to describe a scaphocapitate (SC) arthrodesis in the treatment of stage III Kienböck's disease; second, to report the long-term results of SC arthrodesis; third, to ascertain whether SC arthrodesis provides a viable option for management of this wrist problem and whether there are significant complications.Patients and methodsThis prospective study was conducted in Damanhour National Medical Institute between December 2006 and June 2010. Eighteen patients with stage III Kienböck's disease with no evidence of arthritis of neither the upper pole of capitates nor the radioscaphoid joint were treated with SC arthrodesis using the dorsal approach. The study included five female and 13 male patients. Their age ranged from 20 to 65 years with a mean age of 38 years. The mean follow-up period was 28 months (range 18-61 months).ResultsSix of 18 (33.33%) patients had complete pain relief at rest and activity. Eight (44.45%) had mild pain on performing stressful activity with intermittent use of NSAIDs. The remaining four patients had mild pain at rest; of these four patients, two (11.11%) had mild pain and two (11.11%) had moderate pain on performing stressful activities. The latter two patients, manual workers, had to modify their level of activity. The final results were satisfactory in 14 (77.78%) patients and unsatisfactory in four (22.22%) patients. The results of this study were comparable to the results of SC arthrodesis in other series in the literature.ConclusionSC arthrodesis is a durable procedure that mechanically decompresses the lunate and prevents progressive carpal instability with minimal complications.