gms | German Medical Science

Objectives/Interrogation: When the Kienbock's disease becomes advanced, carpal collapse, joint incongruity, and osteoarthritis develop. For these patients, we have performed the collapsed carpal bone excision, capitate osteotomy and partial intercarpal fusion. At this time, we have formed the newly radio-carpal joint using the articular surface of the proximal capitate. In this study, we report therapeutic results of the procedure on the patients with the advanced Kienbock's disease.

Methods: The materials were 28 patients, consisting of 18 males and 10 female. The mean age at time of surgery was 44.9 years. The stage of these diseases was stage 3b in 9 and 4 in 19 patients. The mean follow-up period was 142.7 months. Of these patients, 10 to 15 years follow-up was 6 patients, and more than 15 years follow-up was 15 patients. Therapeutic results were evaluated based on the scoring system of Evans et al.

Results and Conclusions: For most patients, pain had disappeared after surgery. For only one patient, the intensity of the pain was reduced to a mild level. On the patients, good were achieved in 20 patients, fair in six, poor in two, and very poor in none. In the range of motion at the wrist joint and the grip strength postoperatively, mean palmar flexion was 42.2 °, mean dorsi flexion was 51.7 °, and mean grip strength was 83.1 % of that on the unaffected side. Postoperative radiographs showed that the carpal bone parameters (carpal height index and radio-scaphoid angle) had improved. Although radiographic osteoarthritic changes occurred in all patients, except for moderate limitation of range of motion at the wrist joint, these findings did not affect their level of pain, grip strength, or activity of daily living.

Lunate excision, capitate osteotomy and intercarpal fusion (the modified Graner procedure) is a reliable form of treatment for patients with advanced Kienböck's disease for at least ten years postoperatively.