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Lichtman DM, Pientka WF, MacLean S, Bain G. Precision Medicine for Kienböck Disease in the 21st Century. J Hand Surg Am 2022; 47:677-684. [PMID: 35809999 DOI: 10.1016/j.jhsa.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/13/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023]
Abstract
One of the most popular treatment algorithms for Kienböck disease is based on a progression of successive radiographic changes that was developed in the 1970s. Since then, 2 other important classifications systems have been introduced. One is centered on contrasted magnetic resonance imaging findings and the other, articular cartilage degeneration. All 3 systems have been used, in isolation, to recommend specific treatment modalities. To coordinate all available clinical data and to simplify the treatment selection process, we combined the 3 classification systems into 1 unified classification and treatment algorithm. With the added consideration of some recently introduced surgical options and further knowledge of how Kienböck disease affects children and the elderly, we anticipate that this unified classification system will allow for a more precise and individualized treatment plan.
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Affiliation(s)
- David M Lichtman
- Department of Surgery, Uniformed Services University, School of Medicine, Bethesda, Maryland.
| | - William F Pientka
- JPS Health Network, Department of Orthopaedic Surgery, Fort Worth, Texas
| | | | - Gregory Bain
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
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2
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Kareh AM, Tadisina KK, Chun M, Kaswan S, Xu KY. The Use of Arteriovenous Bundle Interposition Grafts in Microsurgical Reconstruction: A Systematic Review of the Literature. Arch Plast Surg 2022; 49:543-548. [PMID: 35919558 PMCID: PMC9340185 DOI: 10.1055/s-0042-1744424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction. A systematic review of the literature was performed using targeted keywords. Data extraction was performed by two independent authors, and descriptive statistics were used to analyze pooled data. Forty-four patients underwent pedicle lengthening with an arteriovenous graft from the descending branch of the lateral circumflex femoral artery. Most common indications for flap reconstruction were malignancy (
n
= 12), trauma (
n
= 7), and diabetic ulceration (
n
= 4). The most commonly used free flap was the anterolateral thigh flap (
n
= 18). There were five complications, with one resulting in flap loss. Arteriovenous bundle interposition grafts are a viable option for pedicle lengthening when free flap distant anastomosis is required. The descending branch of the lateral circumflex femoral artery may be used for a variety of defects and can be used in conjunction with fasciocutaneous, osteocutaneous, muscle, and chimeric free flaps.
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Affiliation(s)
- Aurora M Kareh
- Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Kashyap Komarraju Tadisina
- Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Magnus Chun
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Sumesh Kaswan
- Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Kyle Y Xu
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida
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3
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Said E, Addosooki A, Assaghir Y, Ahmed A, Tammam H. Radial shortening, bone grafting and vascular pedicle implantation versus radial shortening alone in Kienböck's disease. J Hand Surg Eur Vol 2021; 46:516-522. [PMID: 33601946 DOI: 10.1177/1753193421993730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We prospectively compared outcomes of two surgical procedures for Stage II and IIIa Kienböck's disease with negative ulnar variance. Group I (13 wrists) was treated with radial shortening alone, and Group II (14 wrists) with combined radial shortening, bone grafting and implantation of a vascular pedicle. At follow-up 3 to 7 years (mean 4.5) after operation, scores by the Quick version of the Disability of Arm, Shoulder and Hand questionnaire and scores for pain and grip strength were significantly better in Group II, but the differences were rather small. On MRI all patients in Group II had revascularization, but 11 patients in Group I had not. We conclude that combining radial shortening with the revascularization procedure improved revascularization. Clinically, both treatments were efficient, and the additional bone grafting and vascular pedicle insertion did not greatly improve function, although statistically there were differences in several follow-up variables. This study also could not identify the independent role of the three procedures (drilling, grafting and artery insertion) in Group II, because decompression or bone grafting alone may be effective.Level of evidence: II.
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Affiliation(s)
- Elsayed Said
- Orthopaedic and Traumatology Department, South Valley University, Qena, Egypt
| | - Ahmad Addosooki
- Orthoapedic and Traumatology Department, Sohag University, Sohag, Egypt
| | - Yasser Assaghir
- Orthoapedic and Traumatology Department, Sohag University, Sohag, Egypt
| | - Ahmed Ahmed
- Orthopaedic and Traumatology Department, South Valley University, Qena, Egypt
| | - Hamdy Tammam
- Orthopaedic and Traumatology Department, South Valley University, Qena, Egypt
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4
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Combined vascularized bone graft and scaphocapitate fusion in the treatment of stage III(b) Kienböck’s disease: a cohort study involving 11 patients. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Osteochondral Autograft Transplantation for Hand and Wrist Articular Problems. Tech Hand Up Extrem Surg 2020; 24:166-174. [PMID: 32187174 DOI: 10.1097/bth.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of hand and wrist avascular necrosis with osteochondral fragmentation or focal arthritis can be a challenging problem with a variety procedures described for its treatment. Osteochondral autograft transplantation systems have been utilized in various focal defects of the knee, ankle, elbow, and wrist. The same principle for the treatment of focal defects of the proximal scaphoid, proximal capitate as well as metacarpal head as an alternative treatment is described. The main indication for this treatment is to address focal or partial osteochondral defects where the size of the defect is smaller than the isthmus of the involved bone to accommodate a cylindrical osteochondral graft that can be press fit. Larger and complete defects are contraindications to this treatment. We discuss the surgical technique as well as its main indications and expected outcomes.
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6
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Jung HS, Lee HW, Park MJ. Is Joint Levelling Procedure Better than Temporary Scaphocapitate Pinning in Patients Undergoing Vascularized Bone Graft for Kienböck Disease? J Hand Surg Asian Pac Vol 2019; 24:428-434. [PMID: 31690195 DOI: 10.1142/s2424835519500541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Although there have been many studies of the vascularized bone graft (VBG) or unloading procedures alone for the treatment of Kienböck disease, little information has been reported about patients treated with VBG combined with unloading procedures. The purpose of this study is to 1) describe the outcomes in patients treated with VBG combined with unloading procedures, 2) compare the outcomes according to the unloading procedures and 3) find any radiologic parameters affecting revascularization in Kienböck disease. Methods: A retrospective review was performed involving in 20 patients undergoing 4th and 5th extensor compartmental VBG with unloading procedures for Kienböck disease from 2010-2015. After VBG in all patients, unloading procedures were additionally performed depending on the ulnar variance. These additional operations included joint leveling procedures (radial and capitate shortening osteotomy) or temporary scaphocapitate pinning. Radiologic outcome was evaluated according to Lichtman stage and presence of revascularization evidence. Clinical evaluations included wrist range of motion, grip strength, visual analogue scale (VAS), and Mayo wrist score. Results: VBG with joint leveling procedures was performed in 11 patients (5 radial shortening and 6 capitate shortening) and VBG with temporary scaphocapitate pinning was performed in 9 patients. Although clinical outcomes were not significantly different according to the unloading procedures, there were significantly more patients with evidence of healing of osteonecrosis on radiographs in joint leveling procedure group than temporary scaphocapitate pinning group. Overall, evidence of healing of osteonecrosis was found on plain radiographs in 11 patients and was not found in 9 patients. However, there were no significant preoperative radiological parameters affecting revascularization on radiographs. Conclusions: Not all patients had evidence of revascularization on radiography after VBG combined with unloading procedures for Kienböck disease. However, among the unloading procedures, joint-leveling procedures positively influenced the revascularization process.
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Affiliation(s)
- Hyoung Seok Jung
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Korea
| | - Ho Won Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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Hegazy G, Akar A, Abd-Elghany T, Zayed E, Shaheen E, Mansour T. Treatment of Kienböck's Disease With Neutral Ulnar Variance by Distal Capitate Shortening and Arthrodesis to the Base of the Third Metacarpal Bone. J Hand Surg Am 2019; 44:518.e1-518.e9. [PMID: 30309665 DOI: 10.1016/j.jhsa.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/09/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated whether a surgical technique combining distal capitate shortening and arthrodesis to the base of the third metacarpal bone for the treatment of the early stages (stages II and IIIA) of Kienböck's disease with neutral ulnar variance resulted in pain relief, improvement in wrist motion, or changes in the radiographic evaluation. METHODS This retrospective study reviewed 22 patients with early stages of Kienböck's disease with neutral ulnar variance, treated by distal capitate shortening and arthrodesis to the base of the third metacarpal bone. Patients were divided into 2 groups by disease stage: stage II (n = 12) and stage IIIA (n = 10). There were 8 women and 14 men, with an average age of 35.7 years. The following parameters were measured before and after surgery: visual analog scale (VAS) for pain evaluation, grip strength, range of motion (ROM), ulnar variance, carpal height index, lunate height index, and the scapholunate and scaphocapitate angles. The patients were evaluated in accordance with Modified Mayo Wrist Score (MMWS). RESULTS The average follow-up period was 30.5 months (range, 26-36 months). The stage II group showed significant improvements in the mean VAS (58-5), ROM (57% to 73%), grip strength (54% to 75%), and MMWS (51-78). Patients in the stage IIIA group showed nonsignificant changes in mean VAS score (64-42.5), ROM (52.5% to 55.5%), grip strength (46.5% to 57.5%), and MMWS (36-50.5). Significant decreases in the carpal height index and scaphocapitate angle, and an increase in scapholunate angle in all stage IIIA patients were observed. CONCLUSIONS Distal capitate shortening with capitometacarpal arthrodesis can alleviate pain and improve ROM and grip strength in patients with stage II Kienböck's disease, but not in those with stage IIIA. Moreover, it cannot prevent carpal collapse, especially in stage IIIA of the disease. We do not recommend this technique for treating stage IIIA patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Galal Hegazy
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
| | - Ahmed Akar
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Tharwat Abd-Elghany
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Emad Zayed
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Elsayed Shaheen
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Tarek Mansour
- Radio-diagnosis Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt
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8
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Chou J, Bacle G, Ek ETH, Tham SKY. Fixation of the Fractured Lunate in Kienböck Disease. J Hand Surg Am 2019; 44:67.e1-67.e8. [PMID: 29934081 DOI: 10.1016/j.jhsa.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe an uncommon subset of fractured lunates in Kienböck disease that is salvageable by internal fixation. METHODS We performed a retrospective review for patients with Kienböck disease treated by internal fixation. Demographic data, objective and radiographic measurements, patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and pain (visual analog scale) scores were collected. RESULTS Of the 7 patients treated, 5 were available for review. At an average follow-up of 7.1 years (range, 1.5-15 years), all patients had activity-related wrist pain but were pain-free at rest. Radiographic assessment showed union in all lunates and a normal radioscaphoid angle and Stahl index. The modified carpal height ratio was reduced in 4 patients and normal in one. There was no observed narrowing or irregularity of the radiocarpal or midcarpal joints. Patient-reported outcome measures in 2 patients were unsatisfactory. CONCLUSIONS Computed tomography of the lunate in Kienböck disease is an important investigative tool. A coronal split fracture of these lunates can be salvageable by internal fixation. Revascularization of the lunate can be performed when the fragment is of sufficient size. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Justin Chou
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - Guillaume Bacle
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Melbourne Orthopaedic Group, Victoria, Australia
| | - Eugene T H Ek
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, Tours, France
| | - Stephen K Y Tham
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia.
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9
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Tsantes AG, Papadopoulos DV, Gelalis ID, Vekris MD, Pakos EE, Korompilias AV. The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients. J Hand Microsurg 2018; 11:6-13. [PMID: 30911206 DOI: 10.1055/s-0038-1677318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022] Open
Abstract
Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement ( p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.
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Affiliation(s)
- Andreas G Tsantes
- Department of Orthopedics, University Hospital of Ioannina, Stavros Niarchos Ioannina, Greece
| | | | - Ioannis D Gelalis
- Department of Orthopedics, University Hospital of Ioannina, Stavros Niarchos Ioannina, Greece
| | - Marios D Vekris
- Department of Orthopedics, University Hospital of Ioannina, Stavros Niarchos Ioannina, Greece
| | - Emilios E Pakos
- Department of Orthopedics, University Hospital of Ioannina, Stavros Niarchos Ioannina, Greece
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10
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Kalb K, van Schoonhoven J, Windolf J, Pillukat T. [Treatment of necrosis of the lunate bone]. Unfallchirurg 2018; 121:381-390. [PMID: 29549407 DOI: 10.1007/s00113-018-0477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There still is no standard therapy that predictably results in healing of avascular necrosis of the lunate bone. Nevertheless, there exists a wide spectrum of operative treatment options for different stages. OBJECTIVE This article reviews the treatment options for necrosis of the lunate bone and proposes algorithms based on the age of the patient and condition of the lunate bone and the wrist. METHODS Surgical treatment options for necrosis of the lunate bone can be divided into relieving or revascularization procedures and salvage procedures. RECOMMENDATIONS For patients under 20 years old the treatment of choice is prolonged immobilization, in cases of non-response or progression, minimally invasive and relieving procedures are used. In adult patients with limited affection of the lunate bone the first therapeutic approach should also be immobilization. If in progressive disease or advanced stages only the lunate bone is compromised but reconstructable, restoration should be considered. In progressive collapse of a non-reconstructable lunate bone the therapeutic efforts shift to mobility-preserving procedures utilizing still functional articulations of the wrist. If all functional articulations are lost only classical salvage procedures are feasible. CONCLUSION According to the presented algorithms a stage-dependent therapy of necrosis of the lunate bone is possible. It should not be ignored that there are still no scientific and evidence-based arguments for some of these treatment options. This is also true for maximally invasive procedures, where superiority to more simple procedures have not been proven. Therefore, their application should be restricted and based on an individual decision.
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Affiliation(s)
- K Kalb
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - T Pillukat
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
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Baltzer HL, Riester S, Moran SL. Bilateral Legg-Calve-Perthes Disease and Kienbock's Disease in a Child With Factor V Leiden Thrombophilia: A Case Report. Hand (N Y) 2016; 11:NP16-NP19. [PMID: 27698645 PMCID: PMC5030858 DOI: 10.1177/1558944715627274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The etiology of multifocal osteonecrosis is not definitively known; however, hypercoagulable state is a very plausible cause. Methods: We present an unusual case of a 12-year-old boy with a history of Legg-Calve-Perthes disease presenting with right wrist pain who was subsequently diagnosed with Kienbock's disease. The finding of multifocal osteonecrosis prompted testing for a hypercoagulable state that was positive for Factor V Leiden thrombophilia. A thorough literature review using Medline database was conducted to investigate associations between inherited hypercoagulable states and multifocal osteonecrosis. Results: Our literature review identified 2 similar cases of multifocal osteonecrosis associated with a hypercoagulable disorder in adult patients. There were no reports among the pediatric patient population. Meta-analysis has demonstrated a potential link between Legg-Calve-Perthes disease and Factor V Leiden thrombophilia. Conclusions: This study offers further evidence to support the theory that multifocal osteonecrosis may be linked to a hypercoagulable state. Patients presenting with multifocal osteonecrosis should undergo screening for hypercoagulable states. Further investigation is needed to ascertain the potential benefit of prophylactic anticoagulation in patients with a known hypercoagulable state and multifocal osteonecrosis.
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Affiliation(s)
| | | | - Steven L. Moran
- Mayo Clinic, Rochester, MN, USA,Steven L. Moran, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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12
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Lichtman DM, Pientka WF, Bain GI. Kienböck Disease: Moving Forward. J Hand Surg Am 2016; 41:630-8. [PMID: 27055625 DOI: 10.1016/j.jhsa.2016.02.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/06/2016] [Accepted: 02/21/2016] [Indexed: 02/02/2023]
Abstract
Over the past decade, a plethora of new information has been reported regarding etiology, natural history, classification, and treatment options for lunate osteonecrosis. New disease classifications have been described based on advanced imaging determination of lunate viability as well as a cartilage-based arthroscopic classification. Here we review the newest literature regarding Kienböck disease and present a new treatment algorithm that incorporates the traditional osseous classification system with a perfusion/viability classification and an articular cartilage-based classification.
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Affiliation(s)
- David M Lichtman
- Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX.
| | - William F Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia
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13
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Nakagawa M, Omokawa S, Kira T, Kawamura K, Tanaka Y. Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease. J Wrist Surg 2016; 5:98-104. [PMID: 27104073 PMCID: PMC4838470 DOI: 10.1055/s-0036-1582427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
Purpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients. Average age was 32 years, and radiological grading according to Lichtman classification was stage 2 in 8 patients, stage 3A in 10 patients, and stage 3B in 10 patients. Temporary pinning fixing the midcarpal joint was conducted for 10 weeks postoperatively. Results Follow-up periods averaged 70 months. Pain reduced in 27 patients, and visual analog scale for pain of pre- and postoperative level averaged 59 and 18. Range of wrist flexion and extension motion improved from 87 to 117 degrees, and average grip strength improved from 21 kg preoperatively to 33 kg postoperatively. Carpal height ratio had almost no change from 0.52 to 0.53. Fragmentation of necrotic bone healed in 7 of the 14 cases. Comparative analyses of functional and radiological outcomes between three donor sites found no significant difference. Conclusion Three different vascularized bone grafts from the dorsal wrist and hand area demonstrated favorable and comparable functional outcomes. It was technically important to elevate vascular bundle with surrounding retinaculum or fascia, to include sufficient periosteum, and to insert the vascularized bone as the cortex aligned longitudinally.
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Affiliation(s)
- Makoto Nakagawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Tsutomu Kira
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
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14
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Kawanishi Y, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H. In vivo 3-dimensional analysis of stage III Kienböck disease: pattern of carpal deformity and radioscaphoid joint congruity. J Hand Surg Am 2015; 40:74-80. [PMID: 25534837 DOI: 10.1016/j.jhsa.2014.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/18/2014] [Accepted: 10/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine 3-dimensional carpal alignment and radioscaphoid joint (RSJ) congruity among normal wrists and those with Lichtman stage III Kienböck disease or scapholunate dislocation (SLD). METHODS We conducted 3-dimensional analysis based on computed tomographic data to compare 10 wrists of stage III Kienböck disease (5 IIIa and 5 IIIb) with 5 normal wrists and 3 wrists with SLD. A markerless bone registration technique was used to investigate the 3-dimensional position of the scaphoid relative to the radius. To evaluate RSJ congruency, the inferred contact area between the scaphoid proximal pole and the distal radius was calculated from 3-dimensional bone models. RESULTS The scaphoid position was not significantly different from normal wrists in stage IIIa Kienböck disease. Stage IIIb Kienböck disease was meaningfully associated with a flexed scaphoid and proximal translation of the centroid, but not dorsal translation of the scaphoid proximal pole, where RSJ congruity was preserved. With SLD, the scaphoid flexed to the same extent as that in stage IIIb Kienböck disease, and the proximal pole translated dorsally together with the capitate, producing RSJ incongruity. CONCLUSIONS The patterns of carpal collapse differed between stage IIIb Kienböck disease and SLD in terms of RSJ congruity. Our study showed that stage IIIb Kienböck disease did not involve dorsal subluxation of the scaphoid proximal pole and that RSJ congruity was retained, unlike SLD. CLINICAL RELEVANCE Our results suggest that carpal collapse in Kienböck disease is not associated with RSJ incongruity, which may explain why there are asymptomatic patients with Kienböck disease and carpal collapse.
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Affiliation(s)
- Yohei Kawanishi
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Hisao Moritomo
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan.
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Kazuomi Sugamoto
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
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Derby BM, Murray PM, Shin AY, Bueno RA, Mathoulin CL, Ade T, Neumeister MW. Vascularized bone grafts for the treatment of carpal bone pathology. Hand (N Y) 2013; 8:27-40. [PMID: 24426890 PMCID: PMC3574491 DOI: 10.1007/s11552-012-9479-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.
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Affiliation(s)
- Brian M. Derby
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | - Peter M. Murray
- />Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Alexander Y. Shin
- />Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905 USA
| | - Reuben A. Bueno
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | | | - Tim Ade
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | - Michael W. Neumeister
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
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16
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Wu X, Cai ZD, Lou LM, Chen ZR, Yao ZJ. Treatments for acute and old distal radius fracture with lunate dislocation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23:191-6. [PMID: 23412451 DOI: 10.1007/s00590-012-0945-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/20/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Our study was undertaken to determine the correct treatment protocol for distal radius fracture with lunate anterior dislocation. METHODS From 2000 to 2007, 58 patients (36 with acute injury and 22 with old injury) with distal radius fracture with lunate anterior dislocation were enrolled in the study. Among acute injury patients, 15 were treated through manipulative reduction and plaster fixation and 21 were treated through minimal invasive poking reduction followed by Kirschner wire and plaster fixation. Among old injury patients, 8 underwent operative reduction of lunate dislocation through the palmar approach and Kirschner wire and plaster fixation, whereas 14 patients underwent operative reduction and fixation through the dorsal approach combined with reparation of the dorsal radiolunate ligament. Lidstrom wrist function scores and the morbidity of lunate necrosis and osteoarthritis were documented and evaluated. RESULTS Lidstrom wrist function scores revealed that the rate of excellent and good scores was higher in acute injury patients than in old injury patients (91.7 versus 54.5%, respectively; P = 0.018). The lunate necrosis rate was lower in acute injury patients than in old injury patients (0 versus 27.2%, respectively; P = 0.027). For old injury patients, the lunate necrosis rate was higher in those treated with the palmar approach than in those treated with the dorsal approach (50 versus 14.3%, respectively; P = 0.033). CONCLUSIONS The key points for resolving distal radius fracture with lunate dislocation are prompt and precise diagnosis and treatment of lunate dislocation to prevent old lunate dislocation. We recommend that the surgical procedure is performed through the dorsal approach with reparation of the dorsal radiolunate ligament.
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Affiliation(s)
- Xing Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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Afshar A, Eivaziatashbeik K. Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. J Hand Surg Am 2013; 38:289-96. [PMID: 23313249 DOI: 10.1016/j.jhsa.2012.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the long-term (> 5 y) outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease patients. METHODS In a retrospective study of 16 patients with early stage Kienböck disease, 9 patients with average follow-up of 6.4 years had radial shortening osteotomy (group 1), and 7 with average follow-up of 6.5 years had pedicled vascularized bone graft based on the distal radius 4 + 5 extensor compartmental artery (group 2). The 2 groups were similar in age, sex, operated side, initial Lichtman stage, and follow-up duration. There were significant differences in ulnar variance between the 2 groups. At the last follow-up, the patients were evaluated for pain, wrist motion, grip strength, functional status, and radiographic assessment. The overall results were evaluated by Cooney wrist function score and Nakamura scoring system for Kienböck disease. RESULTS The 2 groups had no significant difference in pain, motion, grip strength, and radiologic assessment; however, grip strength percentage was better in group 2. There was no significant difference between the radiographic changes of the 2 groups. In group I, 7 out of 9 patients had satisfactory Nakamura scores, and 5 out of 9 patients had satisfactory Cooney scores. All of the patients in group 2 had satisfactory Cooney and Nakamura scores. The difference in the mean Cooney wrist function score in the 2 groups was significant. The difference of Nakamura scores in the 2 groups was not significant. CONCLUSIONS Both groups had reasonable long-term outcomes. We were unable to recognize a substantial clinical or radiological difference between the 2 surgical treatments in long-term outcome. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran.
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18
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Abstract
Kienböck disease, or osteonecrosis of the lunate, is a progressive disease process that can lead to wrist pain and dysfunction. Although it was described over 100 years ago, and advances have been made in understanding this disease, the precise etiology remains uncertain. Anatomic, mechanical, vascular, and traumatic factors have been suggested to contribute to the disease. The natural history is unknown, and radiographic and clinical findings do not always correlate. Progress has been made in recognizing the progression of the avascular process and its deleterious effects on wrist mechanics. Initial treatment is nonsurgical, and it remains unclear whether surgical intervention results in improved outcomes over nonoperative treatment. Traditional surgical procedures such as radial shortening osteotomy and proximal row carpectomy have been shown to be reliable treatment options for relieving pain and improving function. Newer procedures such as pedicled bone grafts from the distal radius may improve direct revascularization of the lunate in earlier stages of the disease, potentially arresting the progression of collapse. Additional data are necessary to determine with certainty whether this type of procedure represents an improvement over the traditional treatment alternatives. Kienböck disease remains a challenging problem for hand surgeons.
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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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20
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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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21
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Calfee RP, Van Steyn MO, Gyuricza C, Adams A, Weiland AJ, Gelberman RH. Joint leveling for advanced Kienböck's disease. J Hand Surg Am 2010; 35:1947-54. [PMID: 20971577 PMCID: PMC2998792 DOI: 10.1016/j.jhsa.2010.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 07/19/2010] [Accepted: 08/19/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of joint leveling procedures to treat Kienböck's disease have been limited by the degree of disease advancement. This study was designed to compare clinical and radiographic outcomes of wrists with more advanced (stage IIIB) Kienböck's disease with those of wrists with less advanced (stage II/IIIA) disease following radius-shortening osteotomy. METHODS This retrospective study enrolled 31 adult wrists (30 patients; mean age, 39 y), treated with radius-shortening osteotomy at 2 institutions for either stage IIIB (n = 14) or stage II/IIIA (n = 17) disease. Evaluation was performed at a mean of 74 months (IIIB, 77 mo; II/IIIA, 72 mo). Radiographic assessment determined disease progression. Clinical outcomes were determined by validated patient-based and objective measures. RESULTS Patient-based outcome ratings of wrists treated for stage IIIB were similar to those with stage II/IIIA (shortened Disabilities of the Arm, Shoulder, and Hand score, 15 vs 12; modified Mayo wrist score, 84 vs 87; visual analog scale pain score, 1.2 vs 1.7; visual analog scale function score, 2.6 vs 2.1). The average flexion/extension arc was 102° for wrists with stage IIIB and 106° for wrists with stage II/IIIA Kienbock's. Grip strength was 77% of the opposite side for stage IIIB wrists versus 85% for stage II/IIIA. Postoperative carpal height ratio and radioscaphoid angle were worse for wrists treated for stage IIIB (0.46 and 65°, respectively) than stage II/IIIA (0.53 and 53°, respectively) disease. Radiographic disease progression occurred in 7 wrists (6 stage II/IIIA, 1 stage IIIB). The one stage IIIB wrist that progressed underwent wrist arthrodesis. CONCLUSIONS In this limited series, clinical outcomes of radius shortening using validated, patient-based assessment instruments and objective measures failed to demonstrate predicted clinically relevant differences between stage II/IIIA and IIIB Kienböck's disease. Given the high percentage of successful clinical outcomes in this case series of 14 stage IIIB wrists, we believe that static carpal malalignment does not preclude radius-shortening osteotomy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Afshar A. Lunate revascularization after capitate shortening osteotomy in Kienböck's disease. J Hand Surg Am 2010; 35:1943-6. [PMID: 21115303 DOI: 10.1016/j.jhsa.2010.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of surgical treatment in the early stages of Kienböck's disease is to decrease compressive loading of the lunate to promote revascularization. Capitate shortening osteotomy is one technique that has been advocated in Kienböck's disease with ulnar neutral or positive variance and Lichtman stage I to IIIA. The purpose of this study was to examine the revascularization process of the lunate after capitate shortening osteotomy. METHODS This was a retrospective study of 9 patients with Kienböck's disease with Lichtman stage II or IIIA and ulnar neutral or positive variance. I confirmed avascular necrosis of the lunate in all the patients by magnetic resonance imaging preoperatively. Capitate shortening osteotomy was performed through a dorsal approach and fixed with K-wires. I used magnetic resonance images with fat suppression to detect the revascularization of the lunate after surgery. RESULTS The mean follow-up was 12 months (range, 8-16 mo). All patients demonstrated partial revascularization of the lunate and the mean revascularization time was 4.7 months (range, 3-7 mo), which was interpreted as the beginning of the revascularization process. CONCLUSIONS Capitate shortening osteotomy is an efficient technique to induce the revascularization process in the early stages of Kienböck's disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran.
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23
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Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol 2010; 35:549-54. [PMID: 20621943 DOI: 10.1177/1753193410374690] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The proper treatment of Kienböck's disease, a disorder that displays slow progression with eventual collapse of the lunate and alteration of the surrounding carpal architecture, requires an understanding of its aetiology and natural history. A reproducible classification system assists the surgeon in making appropriate treatment choices. In this discussion, we review the history and rationale for the four-stage step-wise classification system, along with our current treatment algorithm. We also discuss emerging classification systems and speculate on future directions in treatment and research.
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Affiliation(s)
- D M Lichtman
- Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas, Fort Worth, TX, USA
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