gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Pattern of arthritis noted during the surgery for stage 3 B Keinbock’s disease basis for classification and its clinical implication

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  • presenting/speaker Praveen Bhardwaj - Ganga Hospital, Coimbatore, Coimbatore, India

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1443

doi: 10.3205/19ifssh1129, urn:nbn:de:0183-19ifssh11297

Published: February 6, 2020

© 2020 Bhardwaj.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Kienbock's disease or avascular necrosis of the lunate is an uncommon condition affecting the wrist joint. The treatment basically depends on the radiological stage of the disease as described by Lichtman. Beyond 3B the salvage operations are generally recommended. The options include- proximal row carpcectomy, scapho-trapezio-trapezoid (STT) fusion, scapho-capitate fusion, lunate replacement, or a total wrist fusion. Choice of surgery depends on the surgeon's personal preference and the pattern of arthritis seen during the surgery i.e. the involvement of the capitate articular surface or distal radius articular surface. However, the information regarding the arthritic patter seen in Kienbock's disease is sparse in the literature.

Methods: The present study is a prospective observational study involving consecutive 48 patients of stage-3B Kienbock's disease considered for salvage surgery over period of 9 years. The pattern of arthritis involving the wrist joint during the salvage operation was noted.

Results and Conclusions: We noted that out of 48 patients, 22 patients did not have any arthritis whereas in 26 patients arthritis was noted. In 24 of these 26 patients the arthritis involved the lunate articular surface of the radius. In two cases the capitate articular surface involvement was seen without the lunate articular surface involvement. Only in one patient there was arthritis involvement of the scaphoid articular surface of the radius along with arthritic involvement of the lunate articular surface of the radius. These findings form a basis of the classification of the arthritis pattern observed in Kienbock's disease which has been described. Also, it helps in objectively deciding the type of salvage operation recommended. Since the lunate articular surface of the radius is commonly affected in Kienbock's disease one must observe this surface before proceeding for proximal row carpectomy as this surface must be arthritis free for doing a proximal row carpectomy. In such patient a scapho-capitate fusion or STT fusion should be performed. We observed that the scaphoid articular surface is the last to be involved in Kienbock's related arthritis and the lunate articular surface could be the earliest to get involved. This information has great implication when deciding the salvage option for stage-3B Kienbock's disease.