Temporary internal fixation of the scaphotrapezio-trapezoidal joint for the treatment of Kienböck's disease: a preliminary study.

Temporary scaphotrapezio-trapezoidal (STT) fixation with Kirschner wires (K-wires) has been used in the treatment of 16 cases of Kienböck's disease since 1988. Twelve of these cases with a follow-up of at least 1 year were reviewed. Eight patients were women and 4 were men and the average age at the time of surgery was 44 years (range, 20-67 years). Five cases were treated with temporary STT fixation and vascular bundle implantation (group V), and 7 cases were treated with temporary STT fixation and tendon roll implantation (group T). K-wires were removed between 16 and 26 weeks after surgery (average, 18.6 weeks) in group V, and between 8 and 13 weeks (average, 9.7 weeks) in group T. The follow-up periods ranged from 12 to 92 months (average, 38 months). Postoperative wrist pain disappeared in 7 cases and decreased in 5. The postoperative arc of wrist flexion and extension increased from 97 degrees to 108 degrees in group V and from 85 degrees to 103 degrees in group T. Grip strength improved from 22.2 to 30.6 kg in group V and from 11.4 kg to 17.7 kg in group T. X-ray evaluation revealed that the mean carpal height ratio was 0.488 before surgery, 0.489 during STT fixation, and 0.480 at the final follow-up. The carpal height decreased in 3 cases (2 in group V and 1 in group T). The postoperative radioscaphoid angle improved in all cases during K-wire insertion and regressed after removal of the K-wire, eventually showing a decrease in 4 cases, an increase in 3 cases, and no change in 5 cases.