Partial capitate shortening's place of kienböck disease's treatment

Kienböck disease is the progressive disruption of lunate, one of the proximal row carpal bones, as a consequence of avascular necrosis .[1, 2]. As a rare disesase, its real incidence is unknown [3]. While the etiology stays still uncertain; as a result of repetitive trauma noted in these patients, the load on the lunate becomes irregular and excessive[3,14]. Decompressive procedures based on this theory, lowers the load on lunate and permits its revascularization. The clinical condition of Kienböck Disease extends from painless status to an unfunctional condition of the wrist joint. The disease is as mentioned before progressive and may cause fragmentation of lunate, carpal shortening and arthrosis of proximal carpal area. In our study, there were 34 patients, who submit Celal Bayar University Hospital Orthopaedics and Traumatology clinic with Kienböck Disease from january 2001 till december 2012. They were evaluated retrospective and prospectively. These 34 patients were grouped in two based on the type of operation. Partial shortening was performed in first group. In second group, 2-3 supraretinacular artery pedculated bone greft was added to this procedure for vascularisation. The population consists of 15 (44,1%) male and 19 (55,9%) female patients. Male/female ratio was 0,78. Capitate shortening was perfomed to 20 patients (58,8%), and partial shortnening and additional pediculated bone graft procedure were performed to other 14 (41,2%) patients. In all these procedures canulated compression screw was used for fixation after capitate shortening. Lichtmann staging system was used to stage the clinic of our patients. 6 (17,6%) of them was stage 2, 13 (38,2%) of them stage 3-A and 15 (44,1%) of them was stage 3-B In our study, similar results were found in both groups. Mean follow-up time was in first and second group 41 (15-74) and 41 (13-86) months respectively. No significant changes were seen in mean scafolunate and radioscafoid angle, measured pre-operatively and in plain films taken at last control. Stahl index and carpal height ratio were evaulated in both groups. While the patient number with stage 2 was low, stage 2 and stage 3A was grouped in one. In group one, carpal height was conserved in Stage 2 and stage 3A patients, But no significant change was seen in Stage 3B. In group 2, in both stages there was statistically significant raise. As a result, vascularised bone graft procedure is technically difficult with long learning curve. Functional results were similar in both groups, but stahl index and carpal height ratios were significant higher in patients with ravascularisation procedure. Encouraging results were found with vascularisation procedures. 2-3 ICRS is seen surgically safe technique. Our opinion is that except patients with severe radiocarpal arthrosis, these procedures can safely be used in early stages.