LONG TERM RESULTS OF DISTAL CAPITATES SHORTENING WITH CAPITOMETACARPAL ARTHRODESIS FOR TREATMENT OF EARLY STAGES OF KIENBÖCK’S DISEASE

Abstract

Background: The aim of surgical management of Kienbock’s disease has been proposed to slow the progressive osteonecrosis and secondary carpal damage. \nObjective: To evaluate the effect of distal capitate shortening and arthrodesis to the base of the third metacarpal bone for treatment of the early stages of Kienbock’s disease with neutral ulnar variance. \nPatients and Methods: This Retrospective study was conducted on 20 patients managed at the hand surgery unit of Al-Azhar University Hospitals. Patients were divided into 2 groups by disease stage: Stage II (n=14) and stage IIIA (n=6). There were 13 male and 7 female, with an average age of 26.8 years. Parameters measured before and after surgery were visual analogue scale (VAS) for pain evaluation, grip strength, range of motion (ROM), ulnar variance, carpal height index, lunate height index, and the scapholunate and scaphocapitate angles. The patients were evaluated in accordance to Modified Mayo Wrist Score (MMWS). \nResults: The average follow-up period was 7.13 years (range, 6.8 -7.9 years). The stage II group showed significant improvements in the mean VAS (58-5), ROM (57% to 73%), grip strength (54% to 75%), and MMWS (51-78). Patients in the stage IIIA group showed non-significant changes in mean VAS score (64-42.5), ROM (52.5%to 55.5%), grip strength (46.5%to57.5%), and MMWS (36-50.5). Significant decreases in the carpal height index and scaphocapitate angle, and an increase in scapholunate angle in all stage IIIA patients were observed. \nConclusions: Distal capitate shortening with capitometacarpal arthrodesis can decrease pain and improve ROM and grip strength in patients with stage II Kienbock’s disease, but not in those with stage IIIA. Also, it cannot prevent carpal collapse, especially in stage IIIA of the disease. So, this is not recommended for treating stage IIIA patients.