Proximal Row Carpectomy Versus Limited Wrist Arthrodesis for Advanced Kienböck’s Disease

Nakamura, Ryogo; Horii, Emiko; Watanabe, Kentaro; Nakao, Etsuhiro; Kato, Hiroyuki; Tsunoda, Kenji

doi:10.1016/s0266-7681(98)80087-9

Cited by 86 publications

(59 citation statements)

References 22 publications

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“…They therefore advocate more thorough assessment of patients with advanced (stage 3B and stage 4) Kienbock's disease using arthroscopy and MRI scanning. They also conclude that proximal row carpectomy is not a suitable procedure as done by Nakamura et al [8] and recommend that either an excision of lunate, intercarpal arthrodesis or a radiolunate fusion should be used to treat these advanced stages. Our findings were similar and we fully agree that more extensive evaluation with wrist arthroscopy and MRI is indicated in these patients.…”

Section: Discussionmentioning

confidence: 97%

“…Rhee et al [11] concluded that the overall results of proximal row carpectomy are better then any carpal arthrodesis (STT fusion with lunate excision) though the ideal treatment of advanced Kienbock's depends on the patient's age, sex, job and the stage of disease. Nakamura et al [8] had a mixture of limited carpal fusions in their series. They concluded that STT fusion with or without lunate excision and replacement is recommended in selected patients with advanced disease who have a fragmented lunate.…”

Section: Discussionmentioning

confidence: 99%

“…The term 'advanced Kienbock's Disease' [1,8,11,14] has been used in many articles but there is no clear definition or [12,14,16] and wrist fusion [9]. There is no strong evidence to support the use of one procedure over the other.…”

Section: Discussionmentioning

confidence: 99%

“…There is no strong evidence to support the use of one procedure over the other. Nakamura et al [8] and Rhee et al [11] compared limited carpal fusions with proximal row carpectomy. Rhee et al [11] concluded that the overall results of proximal row carpectomy are better then any carpal arthrodesis (STT fusion with lunate excision) though the ideal treatment of advanced Kienbock's depends on the patient's age, sex, job and the stage of disease.…”

Section: Discussionmentioning

confidence: 99%

“…At this stage the lunate is not reconstructable and surgery should be aimed at salvage only. Various treatment options have been tried which include, lunate replacement [7,13,15], lunate excision [5], proximal row carpectomy [1,8,11], limited carpal fusions [6,8,11,14] and wrist fusion. There is no strong evidence to support one procedure over another.…”

Section: Introductionmentioning

confidence: 99%

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Wrist fusion versus limited carpal fusion in advanced kienbock's disease

Tambe

Trail

Stanley

2005

International Orthopaedics (SICO

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We treated 18 patients with advanced Kienbock's disease surgically. Six had total wrist fusions and 12 had limited carpal fusions. The average age was 39.6 yrs and the average follow up was 61.8 months and 66.8 months respectively. The visual analogue pain scores, the patient satisfaction scores and the SF 12 were better in the total wrist fusion group. The DASH (Disabilities of the Arm, Shoulder and Hand) scores, the range of movement and the grip strengths were better in the limited carpal fusions group but this was not statistically significant. Four patients with limited carpal fusions had a non-union that required revising. We believe that total wrist fusion should be offered earlier to patients with advanced stages of the disease, as there are less surgical failures, more satisfied patients, better post operative pain scores and consistent long-term results with less potential for further deterioration with time as compared to other treatment methods.Résumé Nous avons traité chirurgicalement 18 malades avec une maladie de Kienbock avancée. Six malades ont eu une arthrodèse radio-carpienne complète et 12 une arthrodèse carpienne limitée. L'âge moyen était de 39,6 ans et la moyenne de suivi était de 61,8 mois et 66,8 mois respectivement. La score analogique visuel de la douleur, la score de satisfaction des malades et le score SF 12 sont meilleurs dans le groupe fusion complète. Le score DASH (Invalidités Bras, Épaule et Main), l'amplitude de mouvement et la force de préhension étaient meilleurs dans le groupe des fusions carpiennes limitées mais ce n'était pas statistiquement significatif. Quatre malades avec une fusion carpienne limitée avaient une pseudarthrose qui a exigé une révision. Nous croyons que la fusion complète du poignet devrait être offerte plus précocement aux malades aux étapes avancées de la maladie, car il y aurait moins d'échec chirurgicaux, plus de patients satisfaits, de meilleurs résultats sur la douleur, et des résultats plus solides à long terme avec moins de risque de détérioration secondaire, comparée aux autres méthodes du traitement.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%