Fixation of the Fractured Lunate in Kienböck Disease.

J Hand Surg Am

Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia. Electronic address:

Published: January 2019

Purpose: To describe an uncommon subset of fractured lunates in Kienböck disease that is salvageable by internal fixation.

Methods: We performed a retrospective review for patients with Kienböck disease treated by internal fixation. Demographic data, objective and radiographic measurements, patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and pain (visual analog scale) scores were collected.

Results: Of the 7 patients treated, 5 were available for review. At an average follow-up of 7.1 years (range, 1.5-15 years), all patients had activity-related wrist pain but were pain-free at rest. Radiographic assessment showed union in all lunates and a normal radioscaphoid angle and Stahl index. The modified carpal height ratio was reduced in 4 patients and normal in one. There was no observed narrowing or irregularity of the radiocarpal or midcarpal joints. Patient-reported outcome measures in 2 patients were unsatisfactory.

Conclusions: Computed tomography of the lunate in Kienböck disease is an important investigative tool. A coronal split fracture of these lunates can be salvageable by internal fixation. Revascularization of the lunate can be performed when the fragment is of sufficient size.

Type Of Study/level Of Evidence: Therapeutic V.

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Source
http://dx.doi.org/10.1016/j.jhsa.2018.05.008DOI Listing

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