The Results of Conservative Management for Early Stage Kienbock's Disease

Jegal,  Midum; Park,  Min Jong

doi:2014.19.4.180

Arch Hand Microsurg > Volume 19(4); 2014 > Article

Original Article

Journal of the Korean Society for Surgery of the Hand 2014;19(4):180-188.
Published online December 30, 2014.
DOI: https://doi.org/10.12790/jkssh.2014.19.4.180

The Results of Conservative Management for Early Stage Kienbock's Disease

Midum Jegal, Min Jong Park

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. mjp3506@skku.edu

Received: 3 December 2014 • Revised: 15 December 2014 • Accepted: 15 December 2014

Abstract

Purpose
Early stage Kienbock's disease is commonly treated with a surgical intervention to avoid progression to degenerative change. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative management in patients with an early stage Kienbock's disease with a hypothesis that the lunate can be maintained in patients with no pain or tolerable pain.

Methods
Twenty-three patients with a Lichtman stage I, II or IIIA Kienbock's disease were managed conservatively and investigated prospectively. There were ten men and thirteen women. Mean age at first visit was 53.9 years old and mean follow-up period was 51.3 months. The clinical outcomes were evaluated by range of motion, subjective satisfaction of patients at final follow-up. Radiographic measurements of the Lichtman stage were assessed at first visit and at the final follow-up. Three patients were Lichtman stage I, eleven patients were II and nine patients were IIIA.

Results
Range of motion improved in all cases. According to Dornan's criteria, eleven patients were excellent, another eleven patients were good and one patient was fair. Based on Lichtman stage, no change was seen in sixteen patients, while seven showed progression. Three patients revealed improved radiographic findings of the lunate at final follow-up.

Conclusion
We found that conservative management including close observation of clinical and radiographic changes can provide satisfactory clinical improvement in patients with no pain or tolerable pain in early stage Kienbock's disease.