Triscaphe Fusion in the Treatment of Kienbock's Disease : Comparison of Lunate Preservation and Excision / 대한정형외과학회잡지

PURPOSE: To evaluate the necessity and effectiveness of a lunate excision in triscaphe fusion for the treatment of advanced Kienbock's disease. MATERIALS AND METHODS: Twenty-six patients who underwent a triscaphe fusion for Kienbock's disease (IIIb) were analyzed. Fifteen patients received triscaphe fusion only and 11 patients received triscaphe fusion and a lunate excision. The indication for a lunate excision included pain and limited motion due to posterior impingement associated with a severely collapsed lunate. The range of motion and modified Mayo wrist score in the two groups were compared. The carpal height ratio, ulnocarpal distance ratio and radioscaphoid angle were measured on the plain radiographs, and the presence of degenerative change was evaluated. RESULTS: The mean extension range was more preserved in the lunate excision group than in the lunate preserving group. Several radiology indices were similar in the two groups, but a degenerative change in the radioscaphoid joint was observed in 45.5% of the lunate excision group and in 13% of the lunate preserving group. CONCLUSION: When performing the triscaphe fusion in advanced Kienbock's disease, excision of the lunate can relieve the symptoms of posterior impingement. However, this procedure should be carried out carefully because degenerative changes in the radioscaphoid joint are frequently observed.

Triscaphe Fusion with Radial Styloidectomy in Kienbock's Disease / 대한정형외과학회잡지

Neither the cause nor the correct treatment of Kienbocks disease has been clearly established, but its clinical and radiologic presentations have been distinctly defined. There are many controversies concerning therapeutic guidelines for the treatment of Kienbocks disease. The purpose of this study is to evaluate the clinical result of triscaphe fusion with radial styloidectomy of Kienbocks disease. Ten cases of stage III Kienbocks disease by Lichtmans classification were treated by triscaphe fusion with radial styloidectomy from September 1991 to March 1997. We followed up over 24 months and evaluated clinical results. In all cases, pain was relieved. The postoperative results according to Kuschners method revealed three excellent, six good and one fair. The triscaphe fusion and radial styloidectomy was considered as useful method of treatment which has clinical efficacy in Kienbocks disease.

A comparative study of the surgical procedures to treat advanced Kienbock's disease

We have treated a total of 16 cases of advanced Kienbock's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienbock's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienbock's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienbock's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienbock's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.

Triscaphe Fusion in Kienbock's Disease / 대한정형외과학회잡지

There are many controversies concerning therapeutic guidelines for the treatment of Kienbock's disease. We experienced 17 cases of stage II or III Kienbock's disease(Lichtman's classification), which were treated with triscaphe fusion from March 1983 to March 1992. The mean Follow-up peri- od was 25 months. The purpose of this study is to evaluate the clinical and radiological result of triscaphe fusion of 17 cases of Kienbock's disease. 1. The pain was relieved in all cases, but range of motion was not improved after operation. 2. The postoperative results of triscaphe fusion were evaluated by Licthman's method. 9 cases (53%) were rated as satisfactory and 8 cases as unsatisfactory. 75%(3 cases of 4) were rated sat isfactory in IIIA a group and 22%(2 casaes of 9) were rated satisfactory in IIIB group. 3. The psudoarthrosis was noted in 2 cases of 17.

Clinical Study of Kienbock's Disease / 대한정형외과학회잡지

Seventeen cases of Kienbock's disease were treated since 1982, and analysed their clinical outcomes to confine the pathogenesis and to make sure the best way to treat them in various stages. It was not related to trauma around wrist joint (35.3%) but significantly closed to ulnar negative variances(64.7%). Ulnar tilt angle was increased definitely upto 28.9° compared with normal value (22°) in ulnar negative variance, but volar tilt angle was within normal limits. The packing with tensor fascia lata or palmaris longus tendon after the complete excision of avascular lunate could not prevent the collapse of carpal bones at long-term follow-up. But the triscaphe fusion was most effective to maintain the normal wrist anatomy, and radial shortening than ulnar lengtherning is thought to be more effective in wrist biomechanics of kienbock's disease with ulnar negative variances.