Results of Scaphocapitate Arthrodesis in Kienböck Disease

Abstract

Objectives: In this study, it was aimed to evaluate the surgical treatment results of scaphocapitate arthrodesis in Lichtman classification stage 3b and 3c Kienböck disease. Materials and Methods: Eleven patients who had undergone scaphocapitate arthrodesis were included in the study. The mean age of the patients was 41 years. Lunatum was excised in 5 patients and preserved in 6 patients. Fixation was performed with a single screw in 2 patients and with two screws in 9 patients. The mean follow-up time was 18.6 months. Grip and key pinch strengths and wrist range of motion of both hands were recorded at the last follow-up. Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Mayo wrist score and VAS scales for the operated side were also evaluated and recorded. In direct radiographs, bony union, proximal migration of the capitatum and joint degeneration were evaluated. Results: The mean postoperative VAS score was 2.81, and the mean QDASH score was 14. The average Mayo wrist score was 63.63. Postoperative mean wrist flexion was 14.54 degrees and extension was 34.72 degrees. Compared to the non-operated side, there was an 81% reduction in flexion and a 50.4% reduction in extension. The mean grip strength was 15.51 kg and pinch strength was 5.63 kg on the operated side. There was a significant difference in grip strength (p=0.011) compared to the non-operated side, but there was no significant difference in pinch strength values (p=0.417). Radiographically, union had occurred in all patients, there was no proximal migration of the capitatum, and no signs of joint degeneration were detected. Conclusion: After scacocapitate arthrodesis, a significant decrease in wrist joint movements occurs. However, the maintained range of motion remains adequate for functionality. The clinical results are satisfactory as the pain is significantly reduced. This method is a valid treatment option in stage 3b and 3c Kienböck’s disease with low complication and high union rate.

Keywords

• Kienböck Disease
• Scaphocapitate Arthrodesis
• Lichtman Classification

Kienböck Hastalığı’nda Skafokapitat Artrodez Sonuçları

Abstract

Amaç: Bu çalışmada Lichtman sınıflamasına göre evre 3b ve 3c Kienböck hastalığında skafokapitat artrodez cerrahi tedavi sonuçlarının araştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya skafokapitat artrodez yapılmış olan 11 hasta dahil edildi. Hastaların ortalama yaşı 41 idi. Beş hastada lunatum eksizyonu yapılırken, 6’sında yapılmadı. İki hastada tek vida, 9 hastada iki vida ile tespit yapıldı. Ortalama takip süreleri 18,6 (12-37) ay olan hastaların son kontrollerinde her iki elin kavrama ve anahtar çimdikleme kuvvetleri ve el bilek hareket aralıkları kaydedildi. Ameliyat olan tarafa yönelik Quick Disabilities of the Arm, Shoulder and Hand (QDASH) skoru, Mayo el bilek skoru ve VAS skalaları değerlendirildi ve kaydedildi. Direkt radyografi ile kaynama, kapitatumun proksimal göçü ve eklem dejenerasyonu durumu değerlendirildi. Bulgular: Ameliyat sonrası ortalama VAS skoru 2,81, ortalama QDASH skoru 14’tü. Ortalama Mayo el bilek skoru 63,63 idi. Ameliyat sonrası ortalama el bilek fleksiyonu 14,54, ekstansiyonu 34,72 derece idi. Ameliyatsız tarafla karşılaştırıldığında fleksiyonda %81 azalma, ekstansiyonda ise %50,4 azalma vardı. Ameliyat olan tarafta ortalama kavrama gücü 15,51 kg, çimdikleme gücü 5,63 kg idi. Ameliyat olmayan tarafla karşılaştırıldığında kavrama gücünde anlamlı fark varken (p=0,011) çimdikleme gücü değerlerinde anlamlı bir fark yoktu (p=0,417). Radyografik olarak tüm hastalarda kaynama gerçekleşmişti, kapitatum proksimal göçü yoktu ve eklem dejenerasyon bulgusu saptanmadı. Sonuç: Skafokapitat artrodez sonrası el bileği eklem hareketlerinde belirgin azalma olur. Buna rağmen korunan hareket aralığı işlevsellik için yeterli düzeyde kalır. Ağrı belirgin olarak azaldığından klinik sonuçları tatmin edicidir. Bu yöntem düşük komplikasyon ve yüksek kaynama oranı ile evre 3b ve 3c Kienböck hastalığında geçerli bir tedavi seçeneğidir.

Keywords

• Kienböck Hastalığı
• Skafokapitat Artrodez
• Lichtman Sınıflaması

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