Scaphocapitate Fusion with lunatum excision in advanced Kienböck disease: 5.3-year mean follow-up

Abstract

Objective: This study evaluated the clinical and radiological outcomes of scaphocapitate fusion (SCF) performed after lunate excision in patients with advanced Stage III Kienbock's disease. Materials and method: Eleven patients diagnosed with Stage 3 Kienbock's disease who underwent SCF following lunate excision retrospectively evaluated in this study. The scores of arm, shoulder and hand disability (DASH) and Visual Analogue Scores (VAS) recorded preoperatively were also recorded at the final follow-ups after surgery. Wrist ROM (flexion, extension, radial, ulnar) was measured using a goniometer in the operated and contralateral wrists. Grip, tip pinch, key pinch forces and palmar grip were measured using a Jamar dynamometer and pinch gauge (Model SH 5005, South Korea). Results: The study included a total of eleven patients including six female and five male patients. The mean follow-up period was 63.45 months (range 24-86). According to the functional evaluation, the mean preoperative and postoperative Visual Analog Scores (VAS) were 8.45 (range 7-10) and 1.18 (range 0-3), respectively. The mean disabilities of the arm, shoulder and hand (DASH) score was reduced from 52.27 (range 36.40-70) to 16.51 (4.5-47.7) between the preoperative and postoperative periods. According to the evaluation of joint range of motion, the mean range of flexion was 72.9%, the mean range of extension was 84.9%, the mean radial deviation range was 57.35% and the mean ulnar deviation range was 82.46% in the operated hands compared to the contralateral wrist. While wrist flexion and extension ranges exhibited a statistically significant increase, radial deviation exhibited a statistically significant decrease compared to the preoperative period (p<0.05). Conclusion: SCF after lunate excision is a successful surgical method that provides pain relief and increases joint range of motion by maintaining acceptable range of motion in the medium-long term.