Article

Treatment of advanced Kienbock's disease (Lichtmann IV) is commonly proximal row
carpectomy or partial arthrodesis. The purpose of this study is to evaluate a
more conservative treatment of advanced Kienbock's disease for young people:
replacement of the lunate with a costochondral autograft. Between 2007 and 2009,
four patients of mean age 40 years (32-51) were operated by two surgeons using
this technique. This is a prospective study with a final follow-up by an
independent operator. Mean follow-up was 27 months (6-36). Surgery is in two
stages: excision of lunate and replacement with costochondral autograft taken
from the ninth rib. Patients were evaluated with DASH and Cooney scores, pain,
satisfaction, mobility and strength. Results show disappearance of pain at rest
and during daily activities for all patients and a mean DASH of 6.
Flexion-extension was 108 degrees and grip strength 83% compared with the
opposite side. Radiological evaluation showed no disease evolution. No
complication was noted. Functional improvement was significant with good results
compared to conventional techniques. Alternative techniques have been proposed
for the replacement of the lunate, each with its specific problems. Lunate
replacement by a costochondral graft is possible because studies showed vitality
of this free graft up to five years. It also allows subsequent surgery. The absence of carpal collapse and good functional results are encouraging but the
follow up is short. A long-term study is needed to confirm findings.
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Langue : FRANCAIS