The outcome of treatment of Kienbock's disease stage III by excisional arthroplasty and palmaris longus spacer

Al Bayati MA 1, *, Muttar AY 2, Al-Khishali TJ 3, Al Bayati MM 4 and Hameed BM 5

PO Box 38032 Rusafa, Postal Code 12508. Technical Medical College, Al Faradidi University- Baghdad-Iraq.
2 Department of Upper Extremity orthopaedic Surgery, Al Wasity Teaching Hospital.Baghdad -Iraq.
3 College of Dentistry, Department of Dental Surgery, Uruk University- Baghdad - Iraq
4 Department of Orthopaedic Surgery, Skaraborg Hospital Skovde – Sweden.
5 Department of Upper Extremity Orthopaedic Surgery, Al Wasity Teaching Hospital- Baghdad- Iraq
 
Review
International Journal of Science and Research Archive, 2021, 02(02), 158–166.
Article DOI: 10.30574/ijsra.2021.2.2.0074
Publication history: 
Received on 16 April 2021; revised on 18 May 2021; accepted on 20 May 2021
 
Abstract: 
Purpose:  To present the outcomes of treatment of Kienbock's Disease (KD) stage III, by excisional arthroplasty of lunate with Palmaris Longus (PL) tendon as a spacer.
Methods: Twenty-one patients were diagnosed with KD stage III, 14 females, and 7 males. They were treated by excision of the lunate plus PL tendon ball as a spacer. Mean follow up period was 38 months (24-60). Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging (plain and CT scan), MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system.
Results: Nineteen patients improved clinically to a great extent, by relieving symptoms, a better range of movement, functional satisfaction and no conspicuous Carpal Height Ratio (CHR) change. Mean DASH score improved from 38.5 to 6.8. Two patients had less favorable clinical outcome, yet, they were not interested to have further operations.
Conclusions: Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures. Type of study/Level of evidence: Prospective case series, level IV.
 
Keywords: 
Excisional arthroplasty; Kienbock's disease; Lunate collapse; Palmaris longus
 
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