Systematic review of Surgical Management of Early Stages of Kienböck’s Disease

Abstract

Abstract Background Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft. Objective To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease. Methodology The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications. Results This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score. Conclusion Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.