Abstract
We treated 18 patients with advanced Kienbock's disease surgically. Six had total wrist fusions and 12 had limited carpal fusions. The average age was 39.6 yrs and the average follow up was 61.8 months and 66.8 months respectively. The visual analogue pain scores, the patient satisfaction scores and the SF 12 were better in the total wrist fusion group. The DASH (Disabilities of the Arm, Shoulder and Hand) scores, the range of movement and the grip strengths were better in the limited carpal fusions group but this was not statistically significant. Four patients with limited carpal fusions had a non-union that required revising. We believe that total wrist fusion should be offered earlier to patients with advanced stages of the disease, as there are less surgical failures, more satisfied patients, better post operative pain scores and consistent long-term results with less potential for further deterioration with time as compared to other treatment methods.
Résumé
Nous avons traité chirurgicalement 18 malades avec une maladie de Kienbock avancée. Six malades ont eu une arthrodèse radio-carpienne complète et 12 une arthrodèse carpienne limitée. L'âge moyen était de 39,6 ans et la moyenne de suivi était de 61,8 mois et 66,8 mois respectivement. La score analogique visuel de la douleur, la score de satisfaction des malades et le score SF 12 sont meilleurs dans le groupe fusion complète. Le score DASH (Invalidités Bras, Épaule et Main), l'amplitude de mouvement et la force de préhension étaient meilleurs dans le groupe des fusions carpiennes limitées mais ce n'était pas statistiquement significatif. Quatre malades avec une fusion carpienne limitée avaient une pseudarthrose qui a exigé une révision. Nous croyons que la fusion complète du poignet devrait être offerte plus précocement aux malades aux étapes avancées de la maladie, car il y aurait moins d'échec chirurgicaux, plus de patients satisfaits, de meilleurs résultats sur la douleur, et des résultats plus solides à long terme avec moins de risque de détérioration secondaire, comparée aux autres méthodes du traitement.
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Tambe, A.D., Trail, I.A. & Stanley, J.K. Wrist fusion versus limited carpal fusion in advanced kienbock's disease. International Orthopaedics (SICO 29, 355–358 (2005). https://doi.org/10.1007/s00264-005-0013-7
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DOI: https://doi.org/10.1007/s00264-005-0013-7