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American Association for Hand Surgery

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Coronal Plane Fractures of the Lunate in Kienbock Disease: Do They Heal?
Nicholas Munaretto, MD1, Lauren E Dittman, MD1, Karina Lenartowicz, BS1 and Sanjeev Kakar, MD, FAOA2, (1)Mayo Clinic, Rochester, MN, (2)Orthopaedics, Mayo Clinic, Rochester, MN

Hypothesis: The purpose of this study was to assess the union rate, functional outcomes, and reoperation rate of Lichtman IIIC Lunate Coronal Plane Fractures in Kienbock Disease treated with surgical fixation.

Materials and Methods: An IRB approved retrospective review of 64 patients with Lichtman Grade IIIC (lunate fractures) Kienbock disease were analyzed. Of these, 21 patients who underwent procedures to fix the lunate were reviewed. Mayo Wrist Score, pre-operative and post-operative visual analog scale (VAS) pain, range of motion, and grip strength were analyzed. Radiographs and CT scans were reviewed for Lichtman stage, coronal plane fracture location (volar 1/3, central 1/3, dorsal 1/3), lunate union, modified carpal height ratio, Stahl index, and radioscaphoid angle. Fifteen patients with pre-operative and post-operative CT scans were included in the union analysis.

Results: Mean clinical follow-up was 16 months. X-ray and CT scan follow-up were 72.5 and 13.5 months, respectively. Tables 1 and 2 detail the outcomes, union and re-operation rate, and functional outcomes for the cohort. 10 patients underwent vascularized bone grafting (VBG), 8 had joint offloading procedures without internal fixation of the lunate and 3 underwent open reduction internal fixation (ORIF) the fracture, with or without concomitant joint offloading and bone grafting. Patients who had a VBG had a union rate of 22%, none healed within the offloading cohort and there was a 67% union rate in those who underwent ORIF. In terms of reoperation, there were 3 in the VBG, 2 within the offloading group and one within the ORIF group. VAS Pain and grip strength improved post operatively in the entire cohort from 6 to 3 and 14 kg to 28 kg, respectively. Post-operative Mayo Wrist Scores were highest in the vascularized grafts (64) and ORIF groups (58) compared with the offloading procedures alone (45)

Summary Points:

  • Overall union rate was higher for those that underwent open reduction and internal fixation with or without offloading procedures and bone grafting at 67%.
  • Reoperation rate was relatively low at 29% despite the 73% overall non-union rate
    • Vascularized graft, offloading, and ORIF had a 30%, 25% and 33% reoperation rate, respectively
  • Overall, coronal plane fractures of the lunate in Kienbock disease have a poor ability to heal regardless of treatment.

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