Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienbock's€ disease

Abstract

Objective: The aim of this study was to report our results of lunate excision combined with capitohamatefusion in the treatment of Kienbock's€ stage IIIB/IIIC disease.Methods: A total of 7 patients with a mean age 35.2 (SD 11.5) years were enrolled in the study. Pain was the principal reason for surgery. All operations were carried out by the same senior surgeon. Patients were evaluated in terms of range of motion, DASH and VAS scores, satisfaction, and grip/tip/palmar/key pinch strength compared with contralateral sides. Preoperative carpal height indexes and findings of osteoarthritis were determined radiographically and compared with postoperative evaluations.Results: Mean duration of follow up was 15.2 months. Mean DASH and VAS scores were 13.8 2.7 and 2 1.1 respectively. The mean patient satisfaction score was 3.2 0.4 over 4 points. The mean grip strength in the operated hands was 66.4%, palmar pinch was 75.1%, tip pinch was 71.8% and key pinch was 70.4% when compared to the contralateral unaffected sides. The mean flexion range in the operated hands was 58.8%, extension range was 60.3%, radial deviation range was 65.2% and ulnar deviation range was 65.7% when compared to the contralateral sides. There was no significant difference between preoperative and postoperative carpal height ratios (p ¼ 0.086).Conclusions: Our early term results indicate that lunate excision combined with capitohamate fusionmay be an alternative treatment option in patients with stage IIIB and IIIC Kienbock's€ disease.Level of Evidence: Level IV, Therapeutic study.© 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).