An Open and Closed Case For Kienbock's DiseaseDoctors continue to study the best ways to do various operations. Is it better to cut a joint open or to insert an arthroscope and avoid an open operation? The arthroscope is a slender tool with a tiny TV camera on the end that can be inserted into the joint. The doctor can see and carry out the operation with this device.
Researchers in Turkey and the US worked together to answer this question for Kienbock's disease of the wrist. Kienbock's is the loss of blood supply to the lunate bone in the wrist. Without enough blood, the bone starts to break down and collapses. Painful wrist motion and a decrease in strength is the common result.
Treating this condition has always been difficult for hand surgeons. It's not clear what treatment is best. The "wait and see" approach used in the past didn't work. Surgery is advised for more advanced cases. Which operation and how to do it remain unclear.
In this study, 16 patients were divided into two groups. One group had an open operation to put bone graft material into the damaged lunate. A nearby blood vessel was rerouted to the graft for improved healing.
The other group had arthroscopic surgery. Using an arthroscope, the doctor cleaned the area around the lunate, then fused the lunate to the bone next to it. Bringing an extra blood vessel to the area wasn't part of group two's treatment.
Group one (the open operation) had a faster time to fusion. Group two, however, had a shorter operation time, fewer days in the hospital, and faster return to daily activities. Both groups had a big increase in range of motion and grip strength, but these measures didn't return to normal levels for either group.
The authors of this study showed that arthroscopic surgery is superior to an open operation for advanced cases of Kienbock's disease. More studies are needed to see what happens years after this surgery. The use of arthroscopic surgery in earlier stages of the disease also needs further study.
GÃ¼rsel Leblebicioglu, MD, et al. Open Treatment of Stage III Kienbock's Disease With Lunate Revascularization Compared With Arthroscopic Treatment Without Revascularization. In Arthroscopy. February 2003. Vol. 19. No. 2. Pp. 117-130.
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