Kienbock's disease treated with Interposition arthroplasty using Ipsilateral Palmaris Longus Tendon over Titanium Implant
Journal Title: MedPulse -International Medical Journal - Year 2015, Vol 2, Issue 11
Abstract
Kienbock's disease is a rare, debilitating disease process that can lead to chronic pain and dysfunction. Robert Kienböck (1871-1953), an Austrian radiologist, described a disorder in which the lunate bone in the wrist would break down. Kienböck called the disorder "lunatomalacia". Kienbock's disease is an osteonecrosis of lunate bone (lunatomalacia) seen more commonly in males in the second to fourth decade of life. The exact etiology is unknown and symptoms include dorsal wrist pain, wrist stiffness and decreased grip strength. Advanced stages of disease may require lunate excision and filling of the void by various substitutes like silicone implants, tendon grafts etc. We report a case of Kienbock's disease with lunate excision and filling of defect by Palmaris longus Tendon coiled over curved tip of elastic titanium nail and stainless steel wire unit. Here, we report a case of A 40 year old female who presented with progressive wrist pain and difficulty in wrist movements since 7 months. Investigations revealed a diagnosis of grade 4 Kienbock's disease. Lunate excision by a dorsal approach followed by interposition arthroplasty with ipsilateral Palmaris longus tendon coiled over curve tip of elastic titanium nail and stainless steel wire unit was done under regional anesthesia. Nine months post-operatively patient is pain free and wrist movements are full and free. Thus we concluded that in advanced stages of Kienbock’s disease lunate excision surgery is recommended. Post excision void can be filled with coiled Palmaris longus tendon unit coiled over curved tip of elastic titanium nail and stainless steel wire unit together to increase the volume of the graft. This achieves snug fit and also prevents carpal collapse. Our case shows good clinical outcome in short term with no carpal collapse by use of this procedure.
Authors and Affiliations
Navdeep Lokare, Mihir Solanki, Kiran Gaonkar, Nishant Gaonkar, Ketan Gupta, Gaurang Chanchpara, Prashant Alwani
Keywords
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