Total Wrist Fusion in the Management of Kienböck’s Disease

Abstract

Kienbock’s disease is a painful condition that leads to progressive degeneration of the carpus, loss of grip strength and range of motion (ROM). Chondral loss is thought to start in the radiolunate articulation and progress to the capitolunate joint before globally affecting the wrist. In advanced Kienbock’s disease, where chondral loss and loss of carpal height make only salvage possible, the chosen surgical intervention should be directed by the level of symptoms and the anatomical site of degeneration. Motion-sparing procedures have been recommended with variable improvement in pain, ROM, grip strength, and function reported. When these procedures fail, or if degeneration is too advanced, total wrist arthrodesis (TWA) is the only predictable treatment option. Historically, TWA was a difficult procedure with high morbidity. However, with the advent of modern pre-contoured wrist arthrodesis plates reliable high fusion rates with predictable symptom relief can be achieved. Most patients report a high level of satisfaction following TWA despite the consequent loss of wrist function.