Capitate-hamate fusion for treatment of Kienböck’s disease (stages II and IIIA)

Abstract

Background Kienböck’s disease is described as avascular osteonecrosis of the lunate. The capitate-hamate fusion is another means of relieving pressure on the lunate. This procedure is designed for patients with Kienböck’s disease. Aim To evaluate clinical and radiological outcomes of the surgical technique capitate-hamate fusion for the treatment of stages II, III A of Kienböck’s disease with neutral ulnar variance and whether this technique resulted in pain relief, improvement in wrist motion, or changes in the radiographic evaluation. Patients and methods This randomized controlled clinical trial included 20 patients with early stages (stages II and IIIA) of Kienböck’s disease with neutral ulnar variance. The study was carried out in the orthopedic unit of Al-Helal Hospital during the period from March 1st to July 31, 2023. Results Postoperatively, pain, grip strength, range of motion, and the modified Mayo wrist score all increased significantly. There was a significant decrease in carpal height index and lunate height index postoperatively. 65% of patients had stage II Kienböck’s disease, and 35% had stage IIIA Kienböck’s disease. 12 (60%) of patients were excellent, and five (25%) of patients were good. While two patients were fair, and one patient was poor. Conclusion The current study showed that surgical treatment of stages II and IIIA of Kienböck’s disease with neutral ulnar variance by capitate-hamate fusion technique resulted in significant pain relief, improvement in wrist motion, and a significant decrease in carpal height index and lunate height index, with high patient satisfaction.