Early stage 3 Kienböck's disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases. 26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5-9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI. Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%. Overall, 43% good and excellent, 43% fair and 14% poor results were observed.
From 1973 to 1982, seventy‐two total gastrectomies were performed. The Siewert‐Peiper gastric replacement procedure was used in 48 cases, while the Rou‐xen‐Y method was performed in 24 cases. Retrospective analysis showed no significant statistical difference between the 2 methods with regard to postoperative morbidity and mortality. There was an overall mortality rate of 11% and a morbidity rate of 45% (10% anastomosis breakdown, 27% pulmonary complications, 1% bowel obstruction, 7% other complications). As the Roux‐en‐Y anastomosis is technically easier to perform compared to the Siewert‐Peiper gastric replacement and as the functional results from the literature are similar, we will, in the future, favor using the Roux‐en‐Y method in our department.
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