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Scaphocapitate Fusion in the Management of Kienböck's Disease
Ines C. Lin, MD1; Peter Rhee, DO2; Steven L. Moran, MD2; Allen T. Bishop, MD3; Alexander Y. Shin, MD4
1Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN; 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; 4Orthopedic Surgery, Mayo Clinic, Rochester, MN

Hypothesis: Scaphocapitate fusion can be used to offload the lunate and stabilize the wrist in Kienböck’s disease, but descriptions of clinical outcomes of the procedure in patients with Kienböck’s are limited.  We hypothesize that scaphocapitate fusion successfully stabilizes the wrist with some loss of motion in this patient population.

Methods: We identified 36 patients with Kienböck’s disease treated with scaphocapitate fusion at our institution between 1991 and 2010.  Hospital records were reviewed for radiographs, operative details, and pre-operative and post-operative symptoms, range of motion, and grip strength, and complications.  Statistical analysis included paired student’s t-test and chi-square test.

Results: Data from 15 females and 21 males with a mean age of 38 years (range 15-60) and average follow-up period of 38 months (range 2-189) were analyzed.  All patients except for 2 were Lichtman stage 3 to 4.  There were 3 cases of delayed union, 1 case of RSD, 1 scaphoid fracture, and 6 patients who had recurrence of pain and had or were offered additional surgery (30% complication rate).  Significant decreases in post-operative range of motion were noted: extension 37° (pre-operative 48°; p<0.001), flexion 25° (pre-operative 41°; p<0.001), radial deviation 10° (pre-operative 13°; p=0.25), and ulnar deviation 21° (pre-operative 33°; p<0.001).   Grip strength increased to 22 kg post-operatively from 16 kg pre-operatively (p=0.02), although it was still less than the contralateral side (34 kg).

Conclusion: To date, this is the largest series of scaphocapitate fusions to treat patients with Kienböck’s disease.  The procedure was done for patients with more advanced stages although it should be considered in patients who have failed revascularization attempts or with unfavorable lunate fracture patterns, including articular step-offs.  This study shows that scaphocapitate fusion is successful in patients with stage III to IV Kienböck’s disease and results in predictable loss of range of motion and improved grip strength.  Some patients do progress in disease and require additional surgeries.

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