[Long-term results after lunate replacement by the vascularised os pisiform for treatment of Kienböck's disease III b].
Saffar's procedure is used only rarely today. In order to assess the value of this operation in the treatment of advanced Kienböck's disease, after a mean follow-up period of 19 years we could review 7 of 12 patients who had had their lunate replaced by the vascularised pisiform. At the time of follow-up all patients were fully employed without restrictions, and no patient had had to change his job. The mean DASH score was 5.9. The average pain level by VAS was 0.9 and four patients were totally free of pain. Grip strength of the affected arm was reduced to 77% of the opposite side, the active range of motion (extension/flection) was 97 degrees, which was 72% of that of the not affected side. All patients reported high satisfaction with the results of the operation. Although the clinical results were very good, we found substantial radiographical alterations: In 5 patients we found an advanced intercarpal osteoarthritis. Four patients presented a spontaneous synostosis between the pisiform and the triquetrum. The average CHR (carpal height ratio) was 0.43. The presented long-term results after lunate replacement by the vascularised pisiform indicate a high patient satisfaction and very good functional results in spite of significant radiological changes.
Hand- und Plastische Chirurgie, Malteser-Krankenhaus Bonn/Rhein-Sieg, Bonn. dr@maydell.info
B
B
von Maydell
P
P
Brüser
D000328:Adult; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D051220:Pisiform Bone / Q000098:blood supply / Q000637:transplantation*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013580:Synostosis / Q000000981:diagnostic imaging