Orthopaedic Surgery/Kienbock's Disease
Kienbocks, stage IIIA with slightly negative ulnar variance age 40-50. There is as associated coronal plane fracture. Conservative management may be satisfactory if range of motion and grip are good and pain managable with occasional non narcotic analgesic. Pain which requires daily analgesic, which precludes desired avocational activity, which interferes with gainful employment may warrant ameliorative surgery. Radial shortening, the width of two saw blades,or metaphyseal decompression, denervation and orif of the fractured lunate with a herbert screw. Consider arthrocopy to evaluate articular surfaces at the radiocarpal and midcarpal joints to help decide between salvage of the lunate vs PRC. Scaphocapitate arthrodesis or capitate shortening are considerations for destressing the lunate. The patient should understand that wrist arthodesis may be required and the above motion preserving options may offer incomplete or temporary relief. The patient may be well advised to give consent on a contingent basis to arthrodesis if the intraoperative findings suggest an unpredictable outcome from a lesser procedure.