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.

Treatment of kienboeck's disease by radial shortening

8 patients [8 wrists] who had Kienbock disease without degenerative changes in the joints were treated in the period from 1989 to 1992 in El-Minia University Hospital by radial shortening. Small DCP 6 holes was used in all cases through anterior approach of the lower third of radius. The segment of the bone removed was equal to the amount of negative ulnar varience that was measured radiologically pre-operatively. Average follow up period was 9.8 months. There was marked improvement of pain in all cases Range of movement of the wrist was improved in all directions and in all cases. Radiologcal improvement was reported in 2 cases by decreased sclerosis, increased trabecular pattern and increased size of the lunate

Síndrome de Laurence-Moon-Biedl associada a doença de Blount: relato de um caso / Laurence-Moon-Biedl syndrome associated with Blount's disease: report of a case

Apresenta-se o caso de uma paciente de 14 anos portadora da Sindrome de Laurence-Moon-Biedl associada a doença de Blount. Näo há na literatura relatos anteriores de associaçäo entre estas duas doenças