Limited intercarpal fusion as a salvage procedure for advanced Kienbock disease.
BACKGROUND
With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient.


METHODS
We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock's disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013.


RESULTS
Twelve patients were included with a mean age of 41.6 years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1 months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20-110°). The average ulnar deviation was 9° (range 5-15°), and the average radial deviation was 13° (range 5-25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05).


CONCLUSIONS
Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease.
Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA USA.
Matthew L
ML
Iorio
Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA.
Colin D
CD
Kennedy
Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA.
Jerry I
JI
Huang
Intercarpal fusion; Kienbock’s disease; Midcarpal arthrodesis; Proximal row carpectomy; Scaphocapitate; Wrist salvage