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Wrist Fusion Offers Best Option for Kienbck's

N E W Y O R K — Wrist fusion is an irreversible procedure resulting in total loss of radiocarpal movement, but for patients with advanced Kienböck’s disease, it is the treatment of choice, Anant Tambe, M.B., said at the annual meeting of the American Society for Surgery of the Hand. Kienböck’s disease is an avascular necrosis of the lunate bone; its etiology is unknown. In its advanced stages 3 and 4, the condition is characterized by progressive carpal collapse, arthritis, and significant disability. Patients with this condition typically undergo either wrist fusion or one of several types of limited carpal fusion, but there is no published evidence showing that any procedure is optimal, said Dr. Tambe, who conducted the study at the Wrightington, Wigan, and Leigh NHS Trust, England. All patients with Kienböck’s disease in the United Kingdom are referred to Wrightington Hospital in Wigan and are entered into a registry, which currently consists of 223 patients, he said. From this cohort, 18 were identified as having stage 3 or 4 disease and were retrospectively analyzed for outcome following surgery. Of these 18 patients, 6 had undergone wrist fusion and 12 had had limited carpal fusion. The patients’ average age was 39.6 years, and males predominated. The average follow-up was 61.8 months in the wrist fusion group and 66.8 months in the limited carpal fusion group. Pain was rated on a visual analog scale. In the wrist fusion group, pain scores fell from a preoperative average of 8 to 3.3 following surgery, whereas in the carpal fusion group it decreased from a preoperative average of 8.9 to 7.2, Dr. Tambe said. The between-group difference was statistically significant. On other measures, including the disability of arm, shoulder, and hand (DASH) score and the Short Form (SF)-12, which rates overall health status and grip strength, the limited carpal group fared slightly better. The differences were not statistically significant, however. Patient satisfaction was slightly higher in the wrist fusion group. An important finding was that 4 of the 12 patients in the carpal fusion group had been advised to undergo wrist fusion. “At this time, three have undergone repeat surgery and one is awaiting surgery,” he commented. An additional finding in the study was a predictable progressive pattern of arthritis, first with involvement of the midcarpal joints, then the radiolunate joint, then radioscaphoid involvement, and finally global arthritis, he said. ■ Hyaluronan Injections Match Steroids for Thumb Arthritis