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Maniglio M, Zaidenberg EE, Roner S, Habib N, Boretto J, DE Carli P. Is There a Correlation between the Radiological and Clinical Outcome after Core Decompression of the Radius for Kienböck Disease? J Hand Surg Asian Pac Vol 2024; 29:36-42. [PMID: 38299239 DOI: 10.1142/s2424835524500061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Despite the good clinical results in the treatment of Kienböck disease with distal radius core decompression, a radiological progression to a certain degree in the long-term follow-up is possible. Is there a negative correlation between the clinical improvement of the patients and the radiological progression? Methods: We retrospectively reviewed the radiological and clinical results of 24 patients (mean age: 38 years; 10 women) treated with core decompression for Kienböck disease. The mean follow-up was 10 years. Results: A radiologic progression in the Lichtman classification was seen in nine patients. The Spearman correlation did not show any correlation between this radiological progression and the clinical outcome. Namely -0.06 between Mayo and Lichtman classification and 0.16 between VAS and Lichtman classification. Conclusions: We found that the clinical outcomes do not deteriorate despite a radiological progression of patients treated with core decompression for Kienböck disease Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Mauro Maniglio
- Department of Hand Surgery, Balgrist University Clinic, Zürich, Switzerland
| | - Ezequiel E Zaidenberg
- Department of Orthopaedics and Traumatology, HFR Fribourg Cantonal Hospital, University Hospital, Fribourg, Switzerland
| | - Simon Roner
- Department of Orthopaedics and Traumatology, Hospital Italiano Buenos Aires, Buenos Aires, Argentina
| | - Nermine Habib
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Jorge Boretto
- Department of Orthopaedics and Traumatology, HFR Fribourg Cantonal Hospital, University Hospital, Fribourg, Switzerland
| | - Pablo DE Carli
- Department of Orthopaedics and Traumatology, HFR Fribourg Cantonal Hospital, University Hospital, Fribourg, Switzerland
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Muller C, Ardouin L, Fournier A, Gaisne E, Leroy M, Bellemère P. Pyrocarbon interposition implant after lunate resection in Kienböck's disease: A case series. HAND SURGERY & REHABILITATION 2023; 42:34-39. [PMID: 36336267 DOI: 10.1016/j.hansur.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
In advanced stages of Kienböck's disease, the lunate is no longer conservable. One of the surgical options is to resect the lunate and replace it with a prosthesis. The procedure consisted in lunate resection and interposition of a free APSI® or Pi2® pyrocarbon implant through a dorsal approach. Follow-up was clinical and radiological on QuickDASH and PRWE scores. At a median follow-up of 3 years, 12 patients were reviewed, with a median age of 56 years. Flexion significantly decreased from 42° to 28° (p < 0.01). Extension and pronation-supination were conserved. Strength was 94% compared to the opposite side, with no significant difference from the preoperative measurement. Median QuickDASH and PRWE scores were 15.9 and 23.5 respectively and had significantly improved. One patient underwent scaphocapitate fusion because she was still in pain; the other patients were pain-free. No patients had to change jobs because of their wrist. Radiographically, there was no carpal collapse and carpal height was conserved. Radioscaphoid angle and ulnar translation were stable. There was 1 case of asymptomatic implant dislocation. Interposition of a pyrocarbon implant after lunate resection in advanced Kienböck's disease is a motion-conserving procedure that provides pain relief and functional recovery in the short and medium term. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- C Muller
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France.
| | - L Ardouin
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - A Fournier
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - E Gaisne
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - M Leroy
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
| | - P Bellemère
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain, France
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Alao U, Bodansky D, Hajipour L, Hayton M, Talwalkar S. Pyrocarbon Lunate Replacements Perform Well at Two Years: A Retrospective Case Series and Technique from Two UK Tertiary Centres. J Hand Surg Asian Pac Vol 2022; 27:1008-1012. [PMID: 36550080 DOI: 10.1142/s2424835522500965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Methods: Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs. Pre- and postoperative visual analogue scores and movement were documented. Postoperative radiographs were obtained at 6 weeks, 6 months and 1 year. Results: Seven patients were identified, all female, with a median age of 28.0 years. All but one had 3b disease and the median follow-up was 2 years (range 13-112 months). A mean 9/10 preoperative VAS score improved to 1/10 by 3 months postoperatively (p < 0.001, paired t-test). No major complications were seen, and implants were stable radiologically. Conclusions: A semi-constrained pyrocarbon lunate can provide good results for patients with advanced Kienböck's disease, offering an alternative to proximal row carpectomy salvage surgery. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Uthman Alao
- The Upper Limb Unit, Wrightington Hospital, Lancashire, UK
| | - David Bodansky
- The Upper Limb Unit, Wrightington Hospital, Lancashire, UK
| | - Ladan Hajipour
- Orthopaedic Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mike Hayton
- The Upper Limb Unit, Wrightington Hospital, Lancashire, UK
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Catapano J, Higgins JP. An Algorithmic Approach to the Treatment of Kienböck Disease. Hand Clin 2022; 38:417-424. [PMID: 36244709 DOI: 10.1016/j.hcl.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The algorithm and rationale described is a reflection of our own surgical experience for this challenging disorder and can be compared with other publications. Our algorithm has evolved from treatment of a large volume of patients with Kienböck disease in a referral practice. However, it is limited to the management that we have found logical, effective, and within our scope of experience. The treatment guidelines for our specialty as a whole will evolve as our understanding of the etiology and our ability to quantify efficacy improves.
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Affiliation(s)
- Joseph Catapano
- Division of Plastic and Reconstructive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly Wing, Room 4-072, Toronto, ON M5B 1W8, Canada
| | - James P Higgins
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, JPB #200, Baltimore, MD 21218, USA.
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Lockwood WC, Lauder A. Classification and Radiographic Characterization of Kienböck Disease. Hand Clin 2022; 38:405-415. [PMID: 36244708 DOI: 10.1016/j.hcl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Robert Kienböck described radiographic changes associated with idiopathic lunate osteonecrosis in 1910. The radiographic progression of this eponymous condition has been well-described to progress from normal radiographs, to lunate sclerosis, lunate collapse, proximal capitate migration, scaphoid flexion, and pancarpal arthritis. Diagnosing early stages of the disease without radiographic changes presented a challenge. As imaging modalities have evolved, diagnosis has become possible with MRI. Although numerous classification systems exist, the Lichtman classification and the Bain arthroscopic grading system have become widely used. This article outlines the available classification systems and aims to highlight when each may be useful in patient management.
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Affiliation(s)
- W Charles Lockwood
- Department of Orthopedics, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA; Department of Orthopedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80207, USA
| | - Alexander Lauder
- Department of Orthopedics, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA; Department of Orthopedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80207, USA.
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Meena A, Shaina S, Saikia SS, Raj A A, Verma N, Attri M. Management of type 3 Kienbock's disease in manual workers by scaphocapitate fusion with minimum 7-year follow-up. J Clin Orthop Trauma 2022; 28:101854. [PMID: 35433251 PMCID: PMC9006633 DOI: 10.1016/j.jcot.2022.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/05/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Kienbock's disease results in altered wrist biomechanics producing debilitating pain at the wrist. The disease is staged according to radiological and clinical findings and the stage guides the treatment. Various treatment options have been described for stage 3, however, there is a lack of consensus over these treatment methods. Scaphocapitate fusion is the preferred surgical option for advanced Kienbock's disease. Previous studies had heterogeneous cohorts with a short duration of follow-up and a lack of uniform surgical technique. The purpose of the study was to show the long-term functional and radiological outcome of scaphocapitate arthrodesis (SCA) by using Herbert screw for the treatment of Kienbock's disease in manual workers. METHODS For this single-centre, retrospective study, all consecutive patients who were manual workers and managed by SCA between January 2010 and Jan 2014 for Lichtman stage IIIA and IIIB with at least 7 years of follow-up were included. Patients were assessed using clinical and radiological parameters preoperatively and in the follow-up period. Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Related Wrist Evaluation (PRWE), and VAS for pain were assessed. RESULTS Out of 27 patients, 4 lost to follow-up, therefore, 23 patients (14 women and 9 men) with 30 years of median age at the time of the surgery were included. DASH scores, PRWE scores, and VAS for pain significantly improved (p < 0.5) after surgery. Wrist range of motion and grip strength also improved significantly (p < 0.5). Postoperative radiological parameters were found to be within a normal range. CONCLUSION Scaphocapitate fusion by Herbert screws gives good functional, clinical, and radiological outcomes, in stage 3 of Kienbock's disease with excellent rates of fusion with low complications. Even, in manual workers, scaphocapitate fusion can reliably provide good outcomes and this is maintained in the mid to long-term follow-up. Therefore, it should be considered as one of the procedures of choice. LEVEL OF EVIDENCE Retrospective, Level 4.
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Maniglio M, Zaidenberg EE, Thürig G, Gautier E, Boretto JG, DE Carli P. Does Age Affect the Outcomes of Core Decompression for the Treatment of Kienböck Disease? J Hand Surg Asian Pac Vol 2022; 27:83-88. [PMID: 35037578 DOI: 10.1142/s2424835522500035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Core decompression of the distal radius is a minimally invasive technique that has demonstrated good clinical outcomes in the treatment of Kienböck disease. However, the effectiveness of core decompression has not been compared in different age groups. The aim of this study is to compare the outcomes of core decompression in patients <45 years of age to those ≥45 years of age. Methods: This retrospective study included 36 patients with Kienböck disease who were treated with core decompression over a 20-year period. The mean follow-up was 7 years. Outcome measures included visual analogue scale pain score (VAS), active range of flexion/extension at the wrist, grip strength, and modified Mayo wrist score. The patients were divided into two age groups namely <45 years (younger group; n = 22) and ≥45 years (older group; n = 12) and the outcome measures were compared between the two age groups. Results: There were no statistically significant differences between the outcomes of the two age groups. Conclusion: The outcomes of core decompression of the distal radius for Kienböck disease in older patients (≥45 years) are favorable and similar to those seen in younger patients (<45 years). Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Mauro Maniglio
- Department of Hand and Plastic Surgery, Centre hospitalier universitaire Vaudois (CHUV) Lausanne, University Hospital, Lausanne, Switzerland
| | - Ezequiel E Zaidenberg
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gregoire Thürig
- Department of Orthopaedics and Traumatology, HFR Fribourg cantonal Hospital, University Hospital, Fribourg, Switzerland
| | - Emanuel Gautier
- Department of Orthopaedics and Traumatology, HFR Fribourg cantonal Hospital, University Hospital, Fribourg, Switzerland
| | - Jorge G Boretto
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo DE Carli
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gallego Peñalver FJ, Romero de la Higuera SB, Pueyo Ruiz CM, Prados Lumbierres AM. [Childhood Lunatomalacia Or Kienböck Disease With VISI Conformation In A Child: A Case Report And Literature Review]. Rehabilitacion (Madr) 2021; 55:316-319. [PMID: 33276983 DOI: 10.1016/j.rh.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/02/2020] [Indexed: 06/12/2023]
Abstract
Semilunar osteonecrosis or Kienböck's disease has a low prevalence, usually occurring in young men aged between 20 and 40 years. This disease is even less common in childhood. The aetiology varies, with postulation of the vascular trauma theory and the non-traumatic theory, in which the disease is caused by various other mechanisms. Semilunar involvement can occur with bone oedema, fragmentation, and scapholunate misalignment and progresses towards collapse. We present the case of an adolescent boy with Kienböck's disease, with no attributable traumatic antecedent, who developed a complex classification injury on the Litchman scale. Partial improvement of symptoms was achieved with conservative treatment but without definitive pain elimination. Future surgery for this patient is currently being discussed, bearing in mind his skeletal maturity and the pathophysiological progression of the injury.
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Affiliation(s)
- F J Gallego Peñalver
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - S B Romero de la Higuera
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C M Pueyo Ruiz
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A M Prados Lumbierres
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Biomechanical comparison of arthroscopic and open lunate excisions in the cadaveric wrist. Clin Biomech (Bristol, Avon) 2021; 84:105343. [PMID: 33836491 DOI: 10.1016/j.clinbiomech.2021.105343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In advanced Kienböck disease, unreconstructible lunate should be excised as a salvage procedure. There is a lack of information about the biomechanical approaches evaluating the carpal kinematics after lunate excision. We hypothesized that arthroscopic lunate excision would not break the ring structure of the proximal carpal row, preventing carpal instability. We aimed to investigate changes in carpal kinematics following arthroscopic and open lunate excisions. METHODS We used upper extremities from five fresh cadavers and simulated arthroscopic and open lunate excisions. Arthroscopic lunate excision was performed to preserve the attachment sites of intrinsic and extrinsic carpal ligaments to the lunate. Open lunate excision was conducted with sectioning of the intrinsic and extrinsic carpal ligaments. Using a three-dimensional space electromagnetic tracking device, rotation angles of the scaphoid and triquetrum and the change of scaphotriquetrum distance were measured under axial loading. We compared the rotation angles and the change of scaphotriquetrum distance among intact wrists, open, and arthroscopic lunate excisions. FINDINGS No Significant differences in the rotation angle of the scaphoid and triquetrum or the change of scaphotriquetrum distance were found between intact wrist and arthroscopic lunate excision. The triquetrum significantly dorsiflexed and supinated in wrists with open lunate excisions compared with intact wrists. Significant differences in the change of scaphotriquetrum distance were found between intact and openly excised wrists and between arthroscopic and open excisions. INTERPRETATION Arthroscopic lunate excision potentially prevented kinematic change of the proximal carpal row under axial loading by maintaining the integrity of attachment sites of carpal ligaments.
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Abstract
Objectives
This study aims to investigate the reliability of the Lichtman classification among residents, orthopedic surgeons, and hand surgeons. Materials and methods
This study was carried out with 30 male observers (mean age 37.8 years; range, 26 to 62 years) who agreed to participate in the study. All observers were orthopedic surgeons. The observers were separated into three groups that consist of 10 residents, 10 orthopedic surgeons, and 10 hand surgeons. The anteroposterior and lateral wrist radiographs of 20 patients (12 males, 8 females; mean age 49 years; range, 38 to 74 years) diagnosed as Kienböck’s disease were sent to observers via e-mail as a survey. All 40 radiographs were asked to be kept classified. Results
The classification of Kienböck’s disease was analyzed by 30 observers on 40 digital radiographs. The overall agreement with the Lichtman classification was fair within all of the observers (kappa=0.203). When groups were evaluated within themselves, the agreement level was found poor in group 1 (kappa=0.162) and fair in group 2 (kappa=0.210) and group 3 (kappa=0.252). Conclusion A useful classification system in orthopedics and traumatology should classify the type of musculoskeletal disorder reliably, facilitate communication in clinical practice, guide preoperative planning, and enable comparison of results between studies. The Lichtman classification alone is insufficient and should be supported by other imaging and measurement techniques.
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Collon S, Tham S, McCombe D, Bacle G. Scaphocapitate fusion for the treatment of Lichtman stage III Kienböck's disease. Results of a single center study with literature review. HAND SURGERY & REHABILITATION 2020; 39:201-206. [DOI: 10.1016/j.hansur.2020.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
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Agarwala S, Vijayvargiya M. Bisphosphonate combination therapy for non-femoral avascular necrosis. J Orthop Surg Res 2019; 14:112. [PMID: 31018848 PMCID: PMC6480654 DOI: 10.1186/s13018-019-1152-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/11/2019] [Indexed: 02/08/2023] Open
Abstract
Background Avascular necrosis at sites other than femoral head (AVNOFH)/Non-Femoral AVN is a rare entity. No standard of treatment still exists for treating early stages of AVNOFH with most of the cases eventually progressing to a late arthritic stage needing surgical intervention. Bisphosphonates have been shown to prevent disease progression, bone collapse, and the requirement for surgery in avascular necrosis of femoral head. The present study is conducted to evaluate the response of bisphosphonates in the non-surgical management of the early stages of AVNOFH. Materials and methods Prospectively collected data of 20 patients diagnosed with an early stage of AVNOFH and treated with the combination of oral alendronate 70 mg weekly and intravenous zolendronic acid (ZA) for 1 year, between Jan 2009 to Dec 2015, was evaluated retrospectively. Clinical evaluation was done using the visual analogue scale (VAS), mean analgesic requirement, and range of motion. Radiographs and magnetic resonance imaging (MRI) were taken to classify the stage of AVN, monitor radiological collapse, and evaluate radiological progression and bone marrow edema changes. Results In our analysis of 18 patients (2 lost to follow-up), 5 patients had AVN of the humeral head, 4 patients of the talus, 3 of the lunate, and 2 each of the scaphoid, medial tibial plateau, and second metatarsal head. Pain relief with the drop in VAS score was seen at a mean duration of 4.3 weeks (range 3–13 weeks) after the start of therapy. A 50% reduction in mean analgesic requirement was achieved in the first 6 weeks (2-11 weeks). MRI showed complete resolution of BME in 13 patients at 6 months and in 17 patients (94.4%) at 1 year. Radiological collapse was seen in 6 out of 18 patients at a mean follow-up of 35.3 months (range 14–56 months). Only one out of 18 patients enrolled required surgery. Conclusion A combination of oral alendronate and intravenous zolendronic acid provides a pragmatic solution to this rare entity of AVNOFH, where no standard treatment exists.
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Affiliation(s)
- Sanjay Agarwala
- Department of Orthopedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India.
| | - Mayank Vijayvargiya
- Department of Orthopedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
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Kienböck's disease. ACTA ACUST UNITED AC 2015; 34:4-17. [DOI: 10.1016/j.main.2014.10.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 02/06/2023]
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Proximal Row Carpectomy for Coexisting Kienböck's Disease and Giant Intraosseous Ganglion of the Scaphoid: A Case Report and Review of the Literature. Case Rep Orthop 2014; 2014:834063. [PMID: 25530898 PMCID: PMC4235236 DOI: 10.1155/2014/834063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/18/2014] [Accepted: 10/02/2014] [Indexed: 11/23/2022] Open
Abstract
The etiologies of Keinböck's disease and intraosseous ganglion remain unknown. Both entities are rare and the coexistence of these two pathologies in the same patient and hand is even less frequent. We report the case of a 40-year-old man with a longstanding history of martial arts practice (karate) who developed an avascular necrosis of the lunate concomitant with a giant intraosseous ganglion of the scaphoid bone successfully managed by proximal row carpectomy. We review the literature of these two diseases.
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New surgical approach to advanced Kienböck disease: lunate replacement with pedicled vascularized scaphoid graft and radioscaphoidal partial arthrodesis. Tech Hand Up Extrem Surg 2014; 17:72-9. [PMID: 23689852 DOI: 10.1097/bth.0b013e31827f452a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstructive procedures such as proximal row carpectomy or partial arthrodesis have been commonly proposed for advanced Kienböck disease (Lichtmann IIIB to IV). The purpose of this study is to evaluate an alternative surgical technique to advanced Kienböck disease: lunate excision and replacement with pedicled vascularized scaphoid graft and partial radioscaphoidal arthrodesis. The main advantage of the proposed intervention is to preserve mobility while not jeopardizing prime clinical outcomes such as pain. By replacing the devitalized lunate we aim at maintaining midcarpal range of motion, and preventing disease progression with carpal collapse and osteoarthritis of the wrist. Between 2002 and 2008, 13 patients of mean age 41 years (range, 25 to 57 y) were operated using this technique. The surgical act included 3 key steps. First, we excised the lunate, then, filled the generated gap with the rotated scaphoid, using it as a pedicled vascularized autograft. Finally, we performed a partial radioscaphoid arthrodesis. At the final follow-up, none of the intervened patients had pain at rest, and 6 patients could perform nonrestricted daily activities. The average postoperative range of motion in flexion/extension was 70 degrees (range, 55 to 90 degrees), 44% (range, 38% to 54%) of what could be achieved by the contralateral arm, and only 16% (range, 14% to 19%) or 25 degrees (range, 18 to 30 degrees) less than the preoperative range of motion of the same wrist. Grip strength improved by more than 30% (range, 24% to 36%). At an average follow-up of 4 years after surgery, 12 of 13 patients had no radiographic evidence of osteoarthritis or collapse of subchondral bone at the level of the new scaphocapitate joint. At follow-up evaluation, the average DASH score was 14 points (range, 6 to 20). The patients experienced a significant improvement in their functional abilities, achieving good results compared with the conventional techniques. The absence of carpal collapse and good functional results are encouraging.
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Abstract
Kienböck disease, or osteonecrosis of the lunate, most often affects patients between the ages of 20 and 40 years. There are 4 major stages of the disease, and treatment is based on the stage of disease. Advancements are still being made with regards to the cause, pathophysiology, and preferred method of treatment of each stage. Although the goals of pain relief, motion preservation, strength maintenance, and function outcomes are paramount to success, no 1 procedure consistently and reliably achieves these outcomes. Further advancements in treatment and results of long-term outcome studies should resolve some of these topics.
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Affiliation(s)
- Danielle Cross
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA 18015, USA
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Affiliation(s)
- David M. Lichtman
- Department of Orthopaedic Surgery, University of North Texas Health Science Center, John Peter Smith Hospital, Fort Worth, Texas
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Tendon interposition and ligament reconstruction with ECRL tendon in the late stages of Kienböck's disease: a cadaver study. ScientificWorldJournal 2013; 2013:416246. [PMID: 23606814 PMCID: PMC3628666 DOI: 10.1155/2013/416246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The optimal surgical treatment for Kienböck's disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck's disease. METHODS Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. RESULTS It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. CONCLUSION Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones.
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Hohendorff B, Mühldorfer-Fodor M, Kalb K, van Schoonhoven J, Prommersberger KJ. STT arthrodesis versus proximal row carpectomy for Lichtman stage IIIB Kienböck's disease: first results of an ongoing observational study. Arch Orthop Trauma Surg 2012; 132:1327-34. [PMID: 22695760 DOI: 10.1007/s00402-012-1531-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Scapho-trapezial-trapezoidal (STT) arthrodesis and proximal row carpectomy (PRC) are used for the treatment of Lichtman stage IIIB Kienböck's disease. This study prospectively compares 1-year results of STT arthrodesis and PRC in Lichtman stage IIIB Kienböck's disease. MATERIALS AND METHODS Nineteen patients were operated: eight with STT arthrodesis and 11 with PRC. Preoperatively and 1-year postoperatively, mobility and grip strength were examined. Both DASH and Mayo Wrist Scores were obtained from the patients. RESULTS In the STT arthrodesis group, mean extension/flexion worsened from 54 to 39 % of the opposite hand. Grip strength improved from 52.9 to 62.1 %. The DASH Score improved from 32.6 to 21.4, and the Mayo Wrist Score from 50.6 to 57.9. In the PRC group, extension/flexion decreased from 62.5 to 57.0 % of the opposite hand. Grip strength improved from 38.6 to 69.0 %, the DASH Score from 36.7 to 18.9, and the Mayo Wrist Score from 54.6 to 66.0. CONCLUSION One year after operation, slightly better results were observed in patients with PRC compared to STT arthrodesis.
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Affiliation(s)
- Bernd Hohendorff
- Klinik für Handchirurgie Bad Neustadt Saale, Rhön Klinikum AG, Salzburger Leite 1, 97616, Bad Neustadt a. d. Saale, Germany,
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Contact Pressures in Radiocarpal and Triquetrohamate Joints After Vascularized Capitate Transposition. Ann Plast Surg 2011; 67:534-8. [DOI: 10.1097/sap.0b013e318204571f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Willems WF, Alberton GM, Bishop AT, Kremer T. Vascularized bone grafting in a canine carpal avascular necrosis model. Clin Orthop Relat Res 2011; 469:2831-7. [PMID: 21533527 PMCID: PMC3171535 DOI: 10.1007/s11999-011-1893-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 03/29/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited experimental research has been performed on the treatment of avascular necrosis (AVN) by vascularized bone grafting. QUESTIONS/PURPOSES A new model simulating carpal AVN was created to investigate surgical revascularization of necrotic bone. METHODS In seven mongrel dogs, AVN was induced by removal of the radial carpal bones bilaterally, deep-freezing, coating in cyanoacrylate, and reimplantation. A reverse-flow vascularized bone graft from the distal radius was implanted in the avascular radial carpal bone. The contralateral side served as an untreated ischemic control. Bone blood flow, bone volume, radiography, histomorphometry, histology, and MRI were analyzed at 4 weeks. RESULTS Blood flow was substantially higher in grafted bones when compared with controls (14.68 ± 15.43 versus 0.27 ± 0.28 mL/minute/100 g). Blood flow correlated with increased osteoid formation and higher levels of bone turnover. T1 and T2 signals on MRI did not correlate with quantitative bone blood flow measurements. Necrotic bones with no blood flow had normal T1 and T2 signals, whereas revascularized bones had signal changes when compared with adjacent carpal bones. No major collapse occurred in any radiocarpal bone. CONCLUSION In a canine experimental model, investigation of carpal AVN shows the ability of vascularized bone grafting to revascularize and remodel avascular bone. CLINICAL RELEVANCE Surgical revascularization of necrotic bone induced by vascularized bone grafting results in increased bone perfusion and bone remodeling as compared with untreated necrotic bone. MRI T1 and T2 signals can be normal in necrotic avascular bone.
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Affiliation(s)
- Wouter F. Willems
- Department of Orthopedics, Orthopedic Research, Microvascular Research Laboratory, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Gregory M. Alberton
- Department of Orthopedics, Orthopedic Research, Microvascular Research Laboratory, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Allen T. Bishop
- Department of Orthopedics, Orthopedic Research, Microvascular Research Laboratory, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Thomas Kremer
- Department of Orthopedics, Orthopedic Research, Microvascular Research Laboratory, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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Shin M, Tatebe M, Hirata H, Koh S, Shinohara T. Reliability of Lichtman's classification for Kienböck's disease in 99 subjects. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2011; 16:15-8. [PMID: 21348026 DOI: 10.1142/s0218810411005035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/19/2010] [Accepted: 10/25/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease. METHODS Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study. RESULTS Intraobserver reliability was moderate (0.313-0.628), and interobserver reliability was fair (Siegel's kappa = 0.228). CONCLUSION Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.
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Affiliation(s)
- Masaki Shin
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya 466-8550, Japan
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Gittard SD, Narayan RJ, Lusk J, Morel P, Stockmans F, Ramsey M, Laverde C, Phillips J, Monteiro-Riviere NA, Ovsianikov A, Chichkov BN. Rapid prototyping of scaphoid and lunate bones. Biotechnol J 2009; 4:129-34. [PMID: 19156737 DOI: 10.1002/biot.200800233] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, a novel rapid prototyping technology was used to fabricate scaphoid and lunate bone prostheses, two carpal bones that are prone to avascular necrosis. Carpal prostheses were fabricated with an Envisiontec Perfactory SXGA stereolithography system using Envisiontec eShell 200 photocurable polymer. Fabrication was guided using 3-D models, which were generated using Mimics software (Materialise NV, Leuven, Belgium) from patient computer tomography data. The prostheses were fabricated in a layer-by-layer manner; approximately 50-microm thick layers were observed in the prostheses. Hardness and Young's modulus values of polymerized eShell 200 material were 93.8 +/- 7.25 MPa and 3050 +/- 90 MPa, respectively. The minimum compressive force required for fracture was 1360 N for the scaphoid prosthesis and 1248 N for the lunate prosthesis. Polymerized Envisiontec eShell material exhibited high human neonatal epidermal keratinocyte cell viability rate in an MTT assay. The results of this study indicate that small bone prostheses fabricated by stereolithography using eShell 200 polymer may have suitable geometry, mechanical properties, and cytocompatibility properties for in vivo use.
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Affiliation(s)
- Shaun D Gittard
- Joint Department of Biomedical Engineering, University of North Carolina/North Carolina State University, Raleigh, NC 27599-7575, USA
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The treatment of Kienböck disease with vascularized bone graft from dorsal radius. Arch Orthop Trauma Surg 2009; 129:171-5. [PMID: 18270720 DOI: 10.1007/s00402-008-0586-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Numerous surgical treatment options are proposed for the Kienböck disease but there has not been a consensus on the most appropriate method yet. The aim of this study is to present our experience and preliminary results of the use of vascularized bone graft from dorsal radius. MATERIALS AND METHODS Second and third intercompartmental supraretinacular artery pedicled bone graft has been used to treat 11 patients with Kienböck disease between 2001 and 2006. The average follow-up period was 37 months (range 19-77 months). Pre- and post-operative range of motion, pain and grip strength, radiologic parameters such as carpal height ratio, Stahl index and scapholunate angle were evaluated. RESULTS Eleven patients were composed of two stage II, one stage IIIA and eight stage IIIB patients according to Lichtmann classification. At the end of the observation period, five excellent, four good, one fair and one poor results were observed. There were no or little changes in carpal height ratio and Stahl index. Pain has diminished considerably. DISCUSSION We believe that the treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and need no other additional procedures.
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Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. J Hand Surg Am 2008; 33:1478-81. [PMID: 18984326 DOI: 10.1016/j.jhsa.2008.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/09/2008] [Accepted: 06/12/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the biomechanical effect of core decompression of the distal radius for the treatment of Kienböck's disease. METHODS In 7 fresh cadaver upper extremities, axial loads were applied and the pressure in the radiocarpal joint measured using pressure-sensitive film before and after core decompression of the distal radius. RESULTS Biomechanically, the stiffness of the distal forearm statistically decreased significantly from 229.4 N/mm to 198.6 N/mm after core decompression. No or minimal changes in the distribution of the force in each radiocarpal fossa and ulnocarpal fossa, the area of contact in each fossa, and the location of the centroid of force were observed. CONCLUSIONS Core decompression of the distal radius in the setting of Kienböck's disease has been documented good clinical outcomes, yet the biomechanical analysis of this surgical technique does not demonstrate obvious unloading of the lunate.
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Affiliation(s)
- Gary M Sherman
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Institute for Human Performance, Syracuse, NY 13210, USA
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Lumsden BC, Stone A, Engber WD. Treatment of advanced-stage Kienböck's disease with proximal row carpectomy: an average 15-year follow-up. J Hand Surg Am 2008; 33:493-502. [PMID: 18406952 DOI: 10.1016/j.jhsa.2007.12.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 12/19/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the long-term clinical results of a proximal row carpectomy with an average 15-year follow-up for the primary treatment of advanced-stage (Lichtman IIIA and IIIB) Kienböck's disease. This study is a follow-up to a paper by the senior author in a similar cohort of patients where the clinical results of a proximal row carpectomy were evaluated for the treatment of advanced-stage Kienböck's disease at an average 3-year follow-up. METHODS Seventeen patients with a minimum of 10 years of follow-up were identified who met criteria for inclusion. Thirteen of these patients were located and agreed to participate. Patients were seen, examined, and queried regarding their wrists. Range of motion, grip strength, and subjective patient satisfaction were all obtained and quantified using a clinical outcomes scale. RESULTS Twelve of 13 patients demonstrated excellent or good results based on the clinical outcomes scale used (5 excellent, 7 good, 1 fair, and none poor). Total arc of motion averaged 73% of the uninvolved side. Grip strength averaged 92% of the uninvolved side. Compared with preoperative values, range of motion improved an average of 16% and grip strength improved an average of 129%, an overall average improvement of 12 degrees and 18 kg, respectively. At the most recent follow-up, all patients remained employed. Seven patients held manual labor positions, 2 were nurses, and 4 were employed in sedentary vocations. All patients demonstrated some degree of degenerative changes, usually localized to the radiocapitate articulation in the lunate fossa. Clinical results did not correlate with radiographic degeneration. CONCLUSIONS This study demonstrates proximal row carpectomy to be a reliable motion-preserving procedure with good clinical results maintained out to an average of 15 years postoperatively.
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Affiliation(s)
- Boyd C Lumsden
- Hand and Upper Extremity Center of Northeast Wisconsin, Appleton, WI, USA
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Abstract
Kienböck’s disease is a form of osteonecrosis affecting the lunate. Its aetiology remains unknown. Morphological variations, such as negative ulnar variance, high uncovering of the lunate, abnormal radial inclination and/or a trapezoidal shape of the lunate and the particular pattern of its vascularity may be predisposing factors. A history of trauma is common. The diagnosis is made on plain radiographs, but MRI can be helpful early in the disease. A CT scan is useful to demonstrate fracture or fragmentation of the lunate. Lichtman classified Kienböck disease into five stages. The natural history of the condition is not well known, and the symptoms do not correlate well with the changes in shape of the lunate and the degree of carpal collapse. There is no strong evidence to support any particular form of treatment. Many patients are improved by temporary immobilisation of the wrist, which does not stop the progression of carpal collapse. Radial shortening may be the treatment of choice in young symptomatic patients presenting with stages I to III-A of Kienböck’s disease and negative ulnar variance. Many other forms of surgical treatment have been described.
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Affiliation(s)
- F. Schuind
- Department of Orthopaedic Surgery, Erasme University Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - S. Eslami
- Department of Orthopaedics, Hôpital Civil de Charleroi, Boulevard Paul Janson, B-600, Charleroi, Belgium
| | - P. Ledoux
- Centre de Chirurgie de la Main et de Microchirurgie, Clinique du Parc Léopold, 38, rue Froissart, B-1040 Bruxelles, Belgium
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Byrne F, Walls R, Mullett H. Re: flexor pollicis longus rupture 25 years after silicone lunate replacement for stage IV Kienbock's disease. J Hand Surg Eur Vol 2008; 33:84. [PMID: 18332030 DOI: 10.1177/1753193407087890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F. Byrne
- Cappagh National Orthopaedic Hospital, Dublin 11, Ireland
| | - R. Walls
- Cappagh National Orthopaedic Hospital, Dublin 11, Ireland
| | - H. Mullett
- Cappagh National Orthopaedic Hospital, Dublin 11, Ireland
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Streich NA, Martini AK, Daecke W. Proximal row carpectomy: an adequate procedure in carpal collapse. INTERNATIONAL ORTHOPAEDICS 2006; 32:85-9. [PMID: 17089124 PMCID: PMC2219951 DOI: 10.1007/s00264-006-0281-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 07/04/2006] [Accepted: 09/17/2006] [Indexed: 12/14/2022]
Abstract
Proximal row carpectomy (PRC) is an established procedure in the treatment of advanced radiocarpal arthritis. The aim of this study was to evaluate the individual, functional and radiological results in relation to the initial diagnosis. Seventeen patients (15 men, two women), who had undergone PRC, were evaluated. Their average age at the time of the operation was 48 years (range 21-70 years). The most frequent diagnosis leading to PRC was scaphoid non-union advanced collapse (SNAC), which was observed in nine patients, while in three cases each the condition treated had been scapholunate advanced collapse (SLAC) and perilunate dislocation, and in two cases, Kienboeck's disease. At the time of the follow-up examination (median 65.41 months), a significant improvement in the range of movement was seen. While only four (36%) of the patients with SNAC had radiological signs of arthrosis of the radiocapitate joint, visible radiological involvement was noted in all patients who underwent PRC due to scapholunate dissociation and perilunate dislocation. The results of this study show that PRC is a good way of achieving long-term improvement of the degree of subjective freedom from symptoms and of the functional range of movement. Interruption of ligamentous structures, as in scapholunate dissociation and perilunate dislocation, seems to influence the radiological outcome.
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Affiliation(s)
- Nikolaus A Streich
- Department of Orthopaedic Surgery, Universitätsklinik Heidelberg, Heidelberg, Germany.
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Goldfarb CA, Hsu J, Gelberman RH, Boyer MI. The Lichtman classification for Kienböck's disease: an assessment of reliability. J Hand Surg Am 2003; 28:74-80. [PMID: 12563641 DOI: 10.1053/jhsu.2003.50035] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The correct identification of Lichtman stage 3A and 3B Kienböck's disease is crucial for treatment purposes. The present study evaluates the reliability of the Lichtman classification, with specific attention to differentiating stage 3A and 3B. METHODS Four reviewers evaluated wrist radiographs from 39 patients with Kienböck's disease. Radiographs were graded according to the traditional Lichtman classification, a modification of the Lichtman classification using a radioscaphoid angle of 60 degrees to subdivide stage 3, and 8 other radiographic measures. RESULTS The interobserver reliability of the Lichtman classification was substantial (kappa coefficient 0.63), but Stage 3A was less reliably identified (kappa 0.38). The new modification of the Lichtman classification increased both the overall (kappa 0.81) and the stage 3A (kappa 0.75) interobserver reliability. CONCLUSION The use of the radioscaphoid angle increases the interobserver reliability of the Lichtman classification. This should allow a better understanding of the clinically important distinction between stage 3A and 3B disease.
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Affiliation(s)
- Charles A Goldfarb
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University, One Barnes Hospital Plaza, Suite 11300, St Louis, MO 63110, USA
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Abstract
Fifty healthy volunteers were subjected to the CT examination of the wrist joint to provide normal database of the shape and size of the lunate. The various parameters of the lunate were measured taking help of the reformatted images in sagittal, coronal and axial planes. The mean maximum antero-dorsal diameter of the lunate measured on axial section was 16.96mm (SD 1.60) with the range of 13-19mm while the mean medio-lateral diameter of the lunate was 12.80mm (SD 1.37) with the range of 10-15mm. The mean axes of the scaphoid and the triquetral articular surfaces of the lunate were 11.83 degrees (SD 9.33) and 1.54 degrees (SD 9.70), respectively, while the mean axial index was 2.04 (SD 1.33). Lunate is reported to have shapes of three different types on plain radiographs. The CT measurements of most lunates failed to classify them into the described three shapes since many lunates showed dissimilar typing on the various chosen sagittal sections of the same lunate. The classical wedged lunate with its apex towards the dorsum has been described to have a tendency to extend under the capitate compressive force. However, in a study on plain radiography no correlation was reported between the radio lunate angle and the shape of the lunate measured in the direction of the lunate's axis. Our study confirmed the same on plain radiographs and on the CT also. We measured lunate's shape in the direction of the capitate's axis too, which demonstrated significant correlation with the RLA (p<0.001).
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Affiliation(s)
- Ajay Gupta
- Armed Forces Hospital, P.O. Box 454, 13005 Safat, Kuwait.
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Kakinoki R, Matsumoto T, Suzuki T, Funakoshi N, Okamoto T, Nakamura T. Lunate plasty for Kienböck's disease: use of a pedicled vascularised radial bone graft combined with shortening of the capitate and radius. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2001; 6:145-56. [PMID: 11901460 DOI: 10.1142/s0218810401000618] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2001] [Accepted: 05/13/2001] [Indexed: 11/18/2022]
Abstract
We treated eight patients with Kienböck's disease (two patients each with stage 1, 2, 3a and 3b disease by Lichtman's classification) by removing a pedicled, vascularised bone segment from the dorsal aspect of the distal radius and engrafting it into the lunate. Additional shortening of the radius was performed in patients with the ulna-minus or null variant. Shortening of the capitate and capito-hamate fusion were also performed in patients with stage 3 disease. All patients were relieved of their wrist pain at rest and during movement, and the mean grip strength increased from 37% of that in the contralateral hand before surgery to 80% after surgery. The mean post-operative range of motion in the affected wrist was 92% of that in the opposite wrist in patients with stage 1 and 2 disease, and 53% in patients with stage 3 disease. Post-operative assessment revealed that four patients had excellent results, three had good results, and one had a fair result.
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Affiliation(s)
- R Kakinoki
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, 54 Shougoin Kawahara-cho, Sakyo-ku 606-8507, Japan
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Abstract
The treatment results of seven patients (age range, 37 to 74 years, male:female ratio, 1:6) with Kienbock's disease (Lichtman stage IIIA-IIIB) who underwent arthroscopic debridement of the necrotic lunate bone and degenerative intrinsic ligaments were studied retrospectively. Osteoarthritic changes of the articular cartilage were documented in all cases. Partial (n = 2) and complete (n = 5) ruptures of the lunotriquetral and scapholunate ligaments, local synovitis (n = 5), and loose fragments (n = 6) occurred most commonly in the radiocarpal joint. All patients were available for an average of 19 months of follow-up (range, 6 to 42 months), physical examination, and radiographic evaluation. All patients reported significant improvement in pain relief and complete relief of mechanical symptoms. Radiographs showed progression of the disease in three cases; two of these were followed-up for more than 2 years. Arthroscopy in Kienbock's disease allows direct visualization and assessment of the exact pathology of the radiocarpal and midcarpal joint and the lunate cartilage. Arthroscopic debridement of the necrotic lunate increased wrist functional range of motion, provided excellent pain relief, and improved health-related quality of life in all patients.
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Affiliation(s)
- W A Menth-Chiari
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA
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Kaarela OI, Raatikainen TK, Torniainen PJ. Silicone replacement arthroplasty for Kienböck's disease. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1998; 23:735-40. [PMID: 9888671 DOI: 10.1016/s0266-7681(98)80086-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thirty-nine patients with Kienböck's disease underwent silicone replacement arthroplasty between 1979 and 1994. The patients were followed-up from 1 to 18 years (mean, 8 years). Sixteen prostheses (41%) have had to be removed, from 1 to 18 years postoperatively (mean, 5.6 years), 15 of them because of pain and silicone synovitis or cysts. It appears that silicone synovitis with cyst formation is an inevitable problem in the wrist after silicone replacement arthroplasty of the lunate, and this procedure is only a temporary solution for Kienböck's disease.
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Affiliation(s)
- O I Kaarela
- Department of Surgery Oulu University Hospital, Finland.
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Abstract
Between 1985 and 1990, 17 patients with histologically proven Kienböck's disease (Lichtman stages I, II, and III) underwent a combination of cancellous bone grafting to the lunate and external fixation across the wrist. All 17 patients were available for review with a minimum follow-up of 2 years (average, 47 years). Based on pain, functional status, range of motion, and grip strength (Mayo wrist score), there were 6 excellent, 6 good, 2 fair, and 3 poor results (2 of whom required further surgery). An overall success rate of 71% (12 of 17) was achieved. Ten patients underwent postoperative magnetic resonance scanning, and in 5, some improvement in signal intensity was demonstrated. The combination of cancellous bone grafting and external fixation is an alternative treatment for Kienböck's disease.
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Affiliation(s)
- D S Zelouf
- Department of Orthopaedic Surgery, New England Medical Center, Boston, MA, USA
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Watson HK, Monacelli DM, Milford RS, Ashmead D IV. Treatment of Kienböck's disease with scaphotrapezio-trapezoid arthrodesis. J Hand Surg Am 1996; 21:9-15. [PMID: 8775190 DOI: 10.1016/s0363-5023(96)80148-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The long-term results of 28 cases of Kienböck's disease treated with scaphotrapezio-trapezoid arthrodesis between 1980 and 1990 are presented. The average follow-up period was 51 months. Of these wrists, nine required late lunate excision for pain and limited motion; however, only three patients in the entire series required further wrist salvage procedures (wrist arthrodesis, proximal row carpectomy). At late follow-up examination, range of motion averaged 48 degrees in extension, 52 degrees in flexion, 11 degrees in radial deviation, and 27 degrees in ulnar deviation. Using a subjective pain relief rating scale, patients reported excellent results in 12 cases, good results in 9, fair results in 4, and poor results in 2 (1 case was omitted because of a coexisting different disease).
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Affiliation(s)
- H K Watson
- Connecticut Combined Hand Surgery, University of Connecticut, Hartford, USA
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42
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Warren Weissman BN, Simmons BP, Thomas WH. REPLACEMENT OF “OTHER” JOINTS. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Abstract
Sixteen patients with advanced Kienböck's disease (Lichtman stage IIIa and IIIb) were treated with proximal row carpectomy. Two patients were lost to follow-up study. The remaining 14 patients were followed for 3 years (range, 1 to 8 years) and all experienced less pain. Wrist motion was improved or unchanged in 12. Grip strength averaged 72% of the unaffected side. All patients returned to their previous jobs. Proximal row carpectomy in this group of patients provided satisfactory results.
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Affiliation(s)
- B W Begley
- Division of Orthopaedic Surgery, University of Wisconsin Medical School, Madison 53792
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Wachtl S, Sennwald G, Rodriguez M. [Long-term outcome of a silastic semilunar bone prosthesis]. ANNALES DE CHIRURGIE DE LA MAIN ET DU MEMBRE SUPERIEUR : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN = ANNALS OF HAND AND UPPER LIMB SURGERY 1994; 13:36-41. [PMID: 7511909 DOI: 10.1016/s0753-9053(05)80355-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Eight silastic implants of the lunate bone were inserted between 1980 and 1984 on 8 patients. Seven patients were seen, at a ten year follow-up visit and were satisfied with the results. However, STT osteoarthritis secondary to the carpal collapse had to be stabilized by a triscaph arthrodesis. The clinical course showed a clear improvement of force and mobility in a first phase, followed by progressive deterioration ending in a return to preoperative values. Multiple intracarpal cysts were found radiologically in all wrists as well as in the distal radius in two cases and in the metacarpal bones in 3 cases. The height of the prosthesis was decreased by about 36%. Carpal collapse and ulnar translation showed a statistically significant progression. According to these findings, silastic prostheses should no longer be recommended.
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Affiliation(s)
- S Wachtl
- Orthopädische Universitätsklinik Balgrist, Zurich
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Egloff DV, Varadi G, Narakas A, Simonetta C, Cantero C. Silastic implants of the scaphoid and lunate. A long-term clinical study with a mean follow-up of 13 years. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1993; 18:687-92. [PMID: 8308421 DOI: 10.1016/0266-7681(93)90223-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
39 implant replacement arthroplasties were reviewed with a mean follow-up of 13 years. The study includes nine cases of partial replacement of the proximal pole of the scaphoid, 16 cases of total replacement of the scaphoid and 14 cases of replacement of the lunate. In 33 cases the conventional silicone elastomer (CSE) was used and in six the high performance elastomer (HP). Subjective, clinical and radiological evaluations gave different results. Respectively the results were excellent in 41, 23 and 5%, satisfactory in 41, 49 and 39% and poor in 18, 28 and 56% of the cases. Lytic lesions in carpal and/or pericarpal bones were present in all except two cases. Study of the X-rays chronologically revealed that they increased in number and size. Six cases had their implant removed. All had histologically proven silicone synovitis. A major secondary operation has been performed or is foreseen in all cases except one. We do not recommend implant replacement arthroplasty for the scaphoid or the lunate bone.
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Affiliation(s)
- D V Egloff
- Clinique Longeraie, Lausanne, Switzerland
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Abstract
A radiological and histological study of synovitis and bone invasion due to deterioration of a silicone implant of the lunate is presented. The interest of similar observations for osteoarticular pathology is discussed.
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Affiliation(s)
- R Lagier
- Department of Pathology, Geneva Medical School, Switzerland
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