Summary
Kienbock disease, or osteonecrosis of the lunate, is a disorder that displays slow progression with eventual collapse of the lunate and alteration of the surrounding carpal architecture. There are several treatment options for Kienbock disease, largely based on the stage at presentation.
This study evaluated short term results of partial capitate shortening as a treatment modality for twenty consecutive patients suffering from kienbock disease in Lichtman stages II and III a. They were operated on between August 2014 and September 2016 at the Orthopedic Department, Benha University Hospitals-Egypt.
The procedure was performed through dorsal midline direct longitudinal approach over the head of capitate then partial shortening using 3 mm osteotome and fixation using mini screws, Herbert screws or wires.
Union was obtained in all cases as proved by clinical examination and radiographic evaluation. The mean time to union was 6.5 weeks (range 6-8 weeks).
In the final follow-up the postoperative VAS score ranged from 1 to 5 with a mean of 2.8. Four patients were pain free (20%), ten patients had mild pain (50%) and six patients had moderate pain (30%).
The improvements in grip strength are from 45% (range, 10% to 77%) preoperatively to 58.8% (range, 33% to 75%) that of the healthy side postoperatively. This improvement in hand grip was extremely statistically significant (p < 0.0001).
The postoperative flexion ranged from 25% to 87% of the normal side at a mean of 65.2%. This increase was very statistically significant (p = 0.002). The postoperative extension ranged from 35% to 85% of the normal side at a mean of 66%. This increase was extremely statistically significant (p < 0.0001).
As shown from the post operative evaluation, it is clear that partial capitate shortening technique is an effective treatment modality for early stages of kienbock disease (stages II and III a) and can provide a good result in a shortened time interval with improved functional outcome (pain relief, range of motion and hand grip).
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