Wrist Motion Changes after Triscaphe Fusion in Advanced Kienböck’s Disease

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Journal of the Korean Society for Surgery of the Hand 2005;10(2):71-75.
Published online June 1, 2005.

Seung-Koo Rhee, Joo-Hyoun Song, Han-Yong Lee, Seok-Hyun Kim, Joo-Yup Lee

진행된 Kienböck 병에서 삼주상골 유합술 후 수근 관절의 운동 변화

이승구, 송주현, 이한용, 김석현, 이주엽

Abstract

Purpose
To quantify the biomechanical changes in radiocarpal and midcarpal motions after triscaphe fusion for the treatment of advanced Kienböck’s disease using wrist motion radiographs. Materials and Methods: Since 1990, we have treated 11 cases of advanced Kienböck’s disease with triscaphe fusion. Flexion-extension lateral and radioulnar deviation PA radiographs were checked at an average of 42 months. The radius-3rd metacarpal angle was measured to assess wrist range of motion in PA and lateral radiographs. Radiocarpal and midcarpal motions were evaluated by measuring the radiolunate angle and capitolunate angle respectively. The final results were compared with unaffected wrist motions in radiographs. Results: The wrist extension motion after triscaphe fusion was 81% of the unaffected side (mean 51°), but more than 80% of motion occurred at the midcarpal joint. Flexion motion was markedly decreased to 48% of the unaffected side, and the percentage between radiocarpal and midcarpal motion were reversed. Overall, 62% of the range of motion was preserved, and palmar flexion was mostly decreased. We also found 4 cases of radioscaphoid arthritis and 3 cases of scapholunate dissociation. Conclusion: We found excessive motion in the midcarpal joint during wrist extension which may be the cause of scapholunate dissociation and chronic wrist pain. We also found that the fixed flexed position of the scaphoid prevents further flexion of the wrist which may increase radioscaphoid pressure and osteoarthritic change.

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