Treatment of the Advanced Stages of Kienböck’s Disease by Joint Fusion Between Pro-Lunate Iliac Cortico-Cancellous Graft and Scaphoid, Capitate, and Piramidalis Bones

Abstract

After a short analysis of the treatment techniques specifically indicated in the different X-ray stages of Kienbock’s disease, the authors describe their own variation of Duparc’s intercarpal arthrodesis technique for the treatment of the advanced HIB and IV stages of the disease, according to Lichtman’s classification. The modification consists of using small staples instead of a screw for iliac cortico-cancellous bone graft fixation. This method assures perfect graft stability and passive wrist mobilization at the 4th postoperative day, thus obviating the necessity of long immobilization in a plaster cast. The authors present the results at the average follow-up time of 28.5 months in 15 cases treated by substitution of the necrotic lunate bone by autologous implant of iliac bone and intercarpal perineolunate arthrodesis with staples, followed by immediate passive mobilization using the continuous passive motion machine Kinetec (Cogemo S.A., Tournes, France). The constant disappearance of pain coupled with the recovery of good wrist total active movement (TAM average 78°) and excellent stability and grip strength (average 81% of the uninvolved hand) have enabled 13 out of 15 patients to normally resume their former heavy manual jobs. Based on the obtained results, the authors deem this method to be worthy of consideration in carefully selected cases (young patients, heavy manual laborers with advanced Kienbock’s disease) as a good alternative to proximal-row carpectomy or wrist arthrodesis.