ABSTRACT
Necrosis of the lunate requires surgery when it is painful and disabling. Decoulx's stage III is too often beyond reconstructive surgery (lengthening of the ulna, shortening of the radius), while such disabling procedures as wrist arthrodesis are not indicated yet. The intracarpal revascularizing arthrodesis with transposition of the capitate (described by Graner in 1966) is to be considered at this stage. The creation of a new condylar arch coated with cartilage, resembling the physiologic arch, and the preservation of the radio-carpal mobility, allows the return of sufficient motion and strength for everyday needs. The wrist often gets painfree; this procedure should thus be considered as a palliative salvage operation, none the less useful in young manual workers.
Subject(s)
Arthrodesis/methods , Lunate Bone , Osteochondritis/surgery , Osteonecrosis/surgery , Adult , Female , Follow-Up Studies , Humans , Lunate Bone/blood supply , Male , Osteochondritis/diagnostic imaging , Osteonecrosis/diagnostic imaging , Radiography , Range of Motion, Articular , Salvage Therapy , Treatment OutcomeABSTRACT
Graner's intercarpal arthrodesis was performed in 10 patients with Kienböck's disease. The procedure consists in excision of the deformed lunate bone, cartilage resection in the adjacent intercarapal joints (Fig. 5), transverse osteotomy of the capitate bone, transposition of its proximal part to the place of the lunate, fixation with Kirschner wires and filling all the remaining bone spaces with cancellous bone. Postoperative immobilisation was necessary for about three months. Eight of these patients were reviewed 1 to 4 years postoperatively. 40% were free of pain, 50% have some pain and 10% moderate to severe pain. The range of motion in the wrist was restricted between one and two thirds, the strength of the grip on average was one third of the normal values. Severe arthrotic changes were considered as contraindications for this procedure, because their further development was no stopped by the intercarpal arthrodesis and will interfere with the positive aspects of this procedure.