Scaphoid-capitate-hamate-triquetrum Fusion in the Advanced Kienbock's Disease

ABSTRACT

PURPOSE: To evaluate clinical and radiological results of SCHT(scapho-capito-hamato-triquetral) fusion in Lichtman stage IIIB or IV Kienbock's disease. MATERIALS AND METHODS: The result of eight cases, operated and followed since December 2002, were analyzed retrospectively. The indication of SCHT fusion was the advanced Kienbock's disease, in Lichtman stage IIIB or IV, with severe fragmentation of lunate. The fragmented lunate was excised and the intercarpal joint between scaphoid and capitate, capitate and hamate, hamate and triquetrum were fused with joint resection, bone graft and multiple K-wires, to make an horse-shoeshaped carpal bone block. The clinical results were evaluated by wrist pain, ROM, any radiologic changes of wrist at last follow-up and Kuschner's method. RESULTS: There were 3 cases of Stage IIIB and 5 cases of stage IV. Mean follow-up period was 28.9 (range 15-53) months, and mean age at the time of operation was 49.4 (range 33~66) years. Two cases were minus ulnar variance, 4 cases were positive and 2 cases were neutral. The wrist range of motion was decreased from 121.8degreesto 90.6degrees(25%). Carpal height ratio was decreased in 1 case. The last follow-up results according to Kuschner's method revealed 4 excellent, 3 good and 1 fair. CONCLUSIONS: SCHT fustion was considered as one of the favorable salvage procedure for the advanced Kienbock's disease. However, biomechanical study using cadaver, long-term follow-up & accumulation of more cases would be needed to confirm its definitive usefulness in the future.