RESUMO
PURPOSE: The study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck's disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck's disease. METHODS: Thirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck's disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed. RESULTS: For all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively. CONCLUSION: Evidence level: II. Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck's disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck's disease.
RESUMO
Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.