An approach to Kienböck's disease: triscaphe arthrodesis.

Sixteen patients with Kienböck's disease were treated with triscaphe arthrodesis (fusion of the scaphoid, trapezium, and trapezoid) with or without silicone rubber lunate arthroplasty. This approach removes compressive stress from the diseased lunate and treats the accompanying rotary subluxation of the scaphoid. Five patients were treated with triscaphe arthrodesis together with silicone rubber lunate arthroplasty. Three patients, who were symptomatic, after receiving silicone rubber lunate arthroplasty elsewhere, were treated with triscaphe arthrodesis. Eight patients were treated with triscaphe arthrodesis alone, without silicone rubber lunate arthroplasty. Two of these eight patients later required silicone rubber lunate arthroplasty. Radial styloidectomy and small lunate fragment excision were performed later on one patient. After an average follow-up of 20.5 months, relief of pain was satisfactory in all 16 patients. There was neither nonunion nor surgical infection. We believe that triscaphe arthrodesis with a silicone rubber lunate provides a means for load transference and heavy stress use capability of the hand. Triscaphe arthrodesis alone may suffice to bear the wrist load and can be used in an effort to preserve the diseased lunate. A silicone rubber lunate can easily be added at a later date if necessary.