The outcome of treatment of Kienbock's disease stage III by excisional arthroplasty and palmaris longus spacer

Al Bayati Ma Al Bayati Ma,Hameed Bm Hameed Bm,Al-Khishali Tj Al-Khishali Tj,Muttar Ay Muttar Ay,Al Bayati Mm Al Bayati Mm

doi:10.30574/ijsra.2021.2.2.0074

Al Bayati Ma Al Bayati Ma, Hameed Bm Hameed Bm + Show 3 more

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https://doi.org/10.30574/ijsra.2021.2.2.0074

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Abstract

Purpose: To present the outcomes of treatment of Kienbock's Disease (KD) stage III, by excisional arthroplasty of lunate with Palmaris Longus (PL) tendon as a spacer. Methods: Twenty-one patients were diagnosed with KD stage III, 14 females, and 7 males. They were treated by excision of the lunate plus PL tendon ball as a spacer. Mean follow up period was 38 months (24-60). Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging (plain and CT scan), MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system. Results: Nineteen patients improved clinically to a great extent, by relieving symptoms, a better range of movement, functional satisfaction and no conspicuous Carpal Height Ratio (CHR) change. Mean DASH score improved from 38.5 to 6.8. Two patients had less favorable clinical outcome, yet, they were not interested to have further operations. Conclusions: Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures. Type of study/Level of evidence: Prospective case series, level IV.

Highlights

Kienbock's disease (KD) is defined by avascular necrosis of lunate with a predictable pattern of lunate collapse, carpal change, and degeneration, resulting from an apparent combination of vascular, anatomic and traumatic insults.(KD) was first described in 1983 by Peste through his cadaveric work and observations of lunate collapse [1].Corresponding author: Dr Al Bayati Mohammed Ali; Phone:+9647901806170; Email: FRCS Ed, Emeritus Consultant Orthopaedic Surgeon, Department of Upper Extremity orthopaedic Surgery, Al Wasity Teaching Hospital, 1 Senaa St., Karada, Baghdad- Iraq
Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging, MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system
Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures

Summary

Introduction

(KD) was first described in 1983 by Peste through his cadaveric work and observations of lunate collapse [1]. Robert Kienbock, an Austrian Radiologist, after a review of his own 16 and another 20 patients, coined the term of lunatomalacia to describe softening of the bone in the acute process. He concluded that it was due to traumatic causes. His concept was not widely accepted, because ligament tears not found, and dislocation of the lunate never followed by lunatomalacia [2], other causes were hypothesized; anatomical, vascular, and mechanical. Genetic factors were noticed by observations in the first kin and familial clusters [4]

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