Coexisting Kienböck's and Preiser's Disease of the Wrist: Experience with Proximal Row Carpectomy with Dorsal Capsular Interposition Technique

Abstract

Background: Idiopathic avascular necrosis of the lunate is known as Kienböck's disease and that of the scaphoid is known as Preiser's disease. Because the prevalence of coexisting Kienböck's and Preiser's diseases is very low, standardized stages of disease and treatments are not established.

Case presentation: We report coexisting avascular necrosis of the scaphoid and lunate in a 68-year-old woman with no history of steroids or other risk factors. We treated her with proximal row carpectomy with capsular interposition technique. A distal-based dorsal capsular flap was prepared and repaired the palmar capsule. At the last follow-up, she had no pain and had gained improved range of wrist motion. There was no arthritic change at the newly formed radiocapitate joint.

Conclusions: In the case of collapsed lunate and scaphoid with avascular necrosis, the proximal row carpectomy procedure has an advantage. Proximal row carpectomy with dorsal capsular interposition can be performed when the lunate or scaphoid cannot be saved. Arthritic changes of the capitate head and distal radius lunate facet can be covered with the dorsal capsule.

Keywords: Avascular Necrosis; Kienböck's Disease; Lunate; Preiser's Disease; Scaphoid.

Fig. 1

(A) Preoperative range of motion was measured. Wrist extension and flexion was about 40°/10°. (B) On Plain radiograph, proximal scaphoid and lunate were sclerotic and collapsed.

Fig. 2

(A) Lunate fragmentation was found on CT scan. (B) Avascular necrosis of proximal scaphoid and lunate were found. Articular cartilage of lunate fossa and proximal capitate seem to be intact.

Fig. 3

Intraoperative photos and schematic drawings. (A) The dorsal wrist was exposed through the 4th extensor compartment. (B–D) A distal‐based dorsal capsular flap was prepared. (E) A proximal row carpectomy was performed. (F) Articular cartilage of the proximal capitate and lunate fossa of the distal radius were checked. Little arthritic cartilage erosion of the proximal capitate was found at an asterisk. (G) The prepared dorsal capsular flap was tied to the volar capsule (H‐J) Distal–based dorsal capsular interposition after PRC has been done.

Fig. 4

(A) 1 year after operation, range of motion was measured. Wrist extension and flexion was about 60°/30°. ROM was not significantly improved, but her wrist was pain free. (B) On plain radiograph, arthritis of proximal capitate and lunate fossa were not advanced.