Abstract:
Introduction. Kienbock disease is a disorder of lunate bone vascularity that can lead to marked
degeneration of the wrist, reduce grip strength and causes pain, getting to joint disability. The
etiology of the avascular necrosis of the lunate is uncertain, but theories relate to ulnar variance,
the variability of the bone vascularity and intraosseous pressures. Clinical symptoms are very
variable, requiring a high index of suspicion for the diagnosis. Dr. Robert Kienbock an
remarkable radiologist from Vienna (Austria), first described lunato-malacia in 1910 in his
clinical series and initially felt that the cause of the collapse of the lunate was repetitive trauma
to the lunate from work activities. This opinion was support by Muller in 1920 who proposed
the term occupational lunato-malacia. Stahl’s classification, modified by Lichtmann in 1977,
has historically been used to guide management. Despite this disease being described more
than a century ago, the treatment for Kienbock disease still remains controversial.
Aim of the study. We present a review of Kienbock disease and the main objective is to report
our personal experience of surgical treatment of this condition at The Clinical Hospital of
Orthopedics and Traumatology from Chisinau.
Materials and methods. Our experience is based on the surgical treatment of 45 patients with
Kienbock disease, aged between 19 and 59 years, who underwent various surgical treatment.
At 19 patients was performed Graner procedure, scaphoid-trapezium-trapezoid arthrodesis in
10 cases, scapho-capitate arthrodesis in 8 cases, radio-lunate arthrodesis in 4 cases, removing
the first row of carpal bones in 2 cases, by 1 cases with radio-scaphoid and capitato-lunate
arthrodesis.
Results. Arthrodesis directed to obtain ankylosis of the carpal bones by losing the amplitude
of movements but allows to achieve a stable joint, without pain and to restore gripping power.
The advantage of the Graner procedure is restoring the carpal height and maintaining the load
transmitted by the articular surface of the radius in the articular facets of the scaphoid and
semilunar. Long-term results were followed up in 23 patients: good - 12, satisfactory - 9.
Unsatisfactory outcomes were in 2 cases because of the absence of the ankylosis and presence
of the pain.
Conclusions. While the exact cause of Kienbock disease is still poorly understood, several
treatment options are available: revascularization, denervation, intraosseous decompression,
osteotomy in ulnar variants, selective arthrodesis with or without excision of the lunate. From
our experience, the most of patients have good long-term results.
Description:
Department of Orthopedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova,
The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020