الفهرس 
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Abstract
Kienböck’s disease is a form of osteonecrosis affecting the lunate, characterized by necrosis, progressive fragmentation and collapse, ultimately resulting in wrist joint osteoarthritis. Its etiology remains unknown. Morphological variations, such as negative ulnar variance and the particular pattern of its vascularity may be predisposing factors. Wrist pain, swelling, limitation of motion and weak grip are the presentation symptoms. The diagnosis is made on plain radiographs, but MRI can be helpful early in the disease. Treatment options, range from simple observation to complex surgical reconstructions that address either the biologic (loss blood supply) or biomechanical aspects of the disease or both. Nevertheless, there is no strong evidence to support any particular form of treatment.
The aim of this work was to evaluate the results of treatment of stage III Kienbock’s disease by excision of the lunate and either scaphocapitate fusion or four carpal fusion (scapho-capitate-hamate-triquetral fusion).
This study included fourty four patients with stage III kienböck’s disease, the first twenty patients were treated by excision of the lunate, and four carpal fusion using internal fixation and the other twenty four were treated by excision of the lunate and scaphocapitate fusion.
Exclusion criteria were as follows: patients with stage I, II& IV Kienbock, those with extensive degenerative changes of the wrist, those with radioscaphoid joint arthritis.
All patients were examined clinically and radiologically on admission. The age of the patients ranged from 18 to 44 years with an average of 30.66.6 years. There were 21 males and 23 females. The right side was affected in 41 (93.2%), and the left in 3 patients (6.8%). 15 patients (34 %) were heavy manual workers, 13 (29.5%) had office job, and 16 patients (36.5%) were house wives. The mean duration of symptoms was 22.256.22 months.
Pre-operatively, 97.7 of patients complained of severe pain during daily activities. Sense of stiffness was mild persistent in 20 patients (45.5%), and severe in 24 patients (54.5%).work capacity was changed in 15 (41%), changed in 29 (59%), were unable to work. The percentage of affected side grip strength ranged from 30 to 50% with an average of from the normal side. Limitation of wrist motion was observed in all patients. The flexion-extension arc ranged from 50 to 100 degrees with a mean of 79.86.98 degrees.
At final post-operative assessment, according to El-Hadra wrist functional scoring system, the results of treatment of 44 patients, were excellent in 13 patients (29.5%), good in 22 patients (50%), and fair in nine patients (20.5%). 12 patients (27.27%) were pleased with their results, 28 (63.63%) were satisfied, 4 patients (9.10%) were moderately satisfied and no one was unsatisfied. Pain completely relieved in 9 (20.45%), mild in 31 (70.45%), and moderate in 4 patients (9.10%). Supple sense of stiffness was reported by 12 (27.27%), mild by 28 (63.63%), and moderate by 4 patients (9.10%). Those who returned to regular activities were 23 (52.27%) and 19 patients (43.18%) modified their duties. The percentage of grip strength compared with the unaffected side improved to 63. To 85% of the normal side. Flexion-extension arc ranged from 60 to 115 degrees with a mean of 79.86.98 degrees. The final total score increased post-operatively to be range from 15 to 21 points with a mean of 18.811.98 points, which was significantly different from the pre-operative score. There was no statistically significant relationship between patients gender, age, or any factor and the final outcome.