J Korean Soc Surg Hand.  2014 Dec;19(4):180-188. 10.12790/jkssh.2014.19.4.180.

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

• Jegal M
• Park MJ

• KMID: 1896907
• DOI: http://doi.org/10.12790/jkssh.2014.19.4.180

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.

Keyword

Kienbock's; Early stage; Conservative management

MeSH Terms

Female
Follow-Up Studies
Humans
Male
Osteonecrosis*
Prospective Studies
Range of Motion, Articular

Figure

• 

  Fig. 1. (A) Lichtman stage IIIA (case 2, female/56 years) (B) At 3 years, subchondral fracture of the lunate was seen. (C) At 6 years, subchonral fracture was almost healed. (D) At 14 years, although mild collapse of the lunate progressed, carpal height was maintained with no pain.

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  Fig. 2. (A) Lichtman stage I (case 13, female/61 years) (B) At 3 months, subchondral fracture of the lunate was seen. (C) At 6 months, radial side of the lunate was collapsed. (D) At 2 years, definite collapse of the lunate corresponding to Lichtman stage IV was seen.

• 

  Fig. 3. (A) Lichtman stage IIIA (case 3, male/19 years) (B) At 2 years, sclerosis of the lunate almost disappeared. (C) At 3 years, cystic change of the lunate was decreased. (D) At 9 years, sclerosis of the lunate disappeared completely meaning successful revascularization.

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