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Wang F, Wang L, Lv L, Duan W, Xu Y, Zhang X, Ma X, Zhang Z, Shao X. Results after open lunate excision alone or in combination with palmaris longus tendon ball arthroplasty for the treatment of Kienböck's disease. J Orthop Surg Res 2023; 18:476. [PMID: 37391794 DOI: 10.1186/s13018-023-03953-9] [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: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE This study aims to compare results after open lunate excision alone and in combination with palmaris longus tendon ball arthroplasty for the treatment of late-staged Kienböck's disease (KD). METHODS This is a retrospective study using the prospectively collected data, and patients who had a discharge diagnosis of KD (stage IIIB based on Lichtman staging criteria) and underwent surgical treatment by lunate excision alone or in combination with palmaris longus tendon ball arthroplasty between January 2011 and December 2020 were included in this study. Variables of interest involved demographics, disease condition, operative procedure, and the outcomes evaluated at the last follow-up. Within and between comparisons were performed. RESULTS Thirty-five patients underwent lunate excision alone, and 40 patients underwent the combination procedure. At the final follow-up, patients in both groups exhibited significant improvements compared to pre-operation, such as wrist flexion, wrist extension, carpal height ratio, PRWE score, Cooney score, and grip strength (all P < 0.05). Compared to the excision group, combination procedure group had significantly longer surgical time (P < 0.001), more blood loss (P < 0.001) and exhibited better wrist flexion (P = 0.001), PRWE score (P = 0.001), Cooney score (P = 0.0034), and grip strength (P = 0.017). The excellent or good rate based on Cooney wrist score was not significantly different (87.5% vs 71.4%, P = 0.083). CONCLUSION Lunate excision in combination with palmaris longus tendon ball arthroplasty is a better option than lunate excision alone for the treatment of stage III KD and can be considered as an operative option.
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Affiliation(s)
- Fengyu Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Lv
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wenxu Duan
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yali Xu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaoran Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xuelin Ma
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhemin Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xinzhong Shao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Nicholson LT, Pidgeon TS, Lauder A, Rellan I, Richard MJ, Ruch DS. Lunate Revascularization With Temporary Internal Radiocarpal Spanning Fixation for Kienböck Disease. Hand (N Y) 2023; 18:126-132. [PMID: 33855882 PMCID: PMC9806532 DOI: 10.1177/15589447211006858] [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: 01/05/2023]
Abstract
BACKGROUND The goal in the treatment of stages II and III Kienböck disease is to restore lunate vascularity and halt the progression of avascular necrosis. METHODS We report the outcomes for patients with stages II and III Kienböck disease treated with fourth extensor compartment artery vascularized bone grafting and temporary radiocarpal spanning internal fixation. Nine patients with a mean age of 28.8 years were included. Mean clinical and radiographic follow-up were 4.9 and 1.9 years, respectively. RESULTS Six patients had no change in Lichtman stage, 2 patients regressed 1 stage, and 1 patient progressed 1 stage. Mean postoperative quick disabilities of the arm, shoulder, and hand (QuickDASH) was 17.4. Mean postoperative visual analogue pain scale (VAS) was 1.8. Patients under age 25 trended toward improved clinical outcomes compared with patients over age 25. Two patients, aged 33 and 65, underwent proximal row carpectomy at a mean 30.5 months postoperatively. CONCLUSIONS In conclusion, the use of local vascularized bone graft with temporary internal radiocarpal spanning fixation provides a treatment option with outcomes comparable to existing literature with benefits inherent to internal immobilization.
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Abstract
Avascular necrosis is a complicated, multifactorial disease with potentially devastating consequences. Although the underlying root cause is a lack of appropriate vascular perfusion to affected bone, there are often varying patient-specific, anatomic-specific, and injury-specific predispositions. These factors generally fall into 3 categories: direct vascular disruption, intravascular obliteration, or extravascular compression. The initial stages of disease can be insidiously symptomatic because edematous bone marrow progresses to subchondral collapse and subsequent degenerative arthritis. Although much of the current literature focuses on the femoral head, other common areas of occurrence include the proximal humerus, knee, and the carpus. The low-incidence rate of carpal avascular necrosis poses a challenge in establishing adequately powered, control-based validated treatment options, and therefore, optimal surgical management remains a continued debate among hand surgeons. Appreciation for expectant fracture healing physiology may help guide future investigation into carpal-specific causes of avascular necrosis.
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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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Henry M, Lundy FH, Henry GK. Matching Kienböck's Treatment Options to Specific Features of Each Case. J Hand Microsurg 2021; 15:87-97. [PMID: 37020608 PMCID: PMC10070007 DOI: 10.1055/s-0041-1730888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck's patients through the early, transitional, and late phases of the disease.
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Affiliation(s)
- Mark Henry
- Hand and Wrist Center of Houston, Houston, Texas, United States
- Address for correspondence Mark Henry, MD Hand and Wrist Center of Houston1200 Binz Street, Suite 1390, Houston TX - 77004United Sates
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Güvenç K, Asfuroğlu ZM, Yılmaz C, Eskandari MM. Effect of gadolinium perfusion magnetic resonance imaging on surgeons' management preferences in kienböck's disease. A survey study. HAND SURGERY & REHABILITATION 2021; 40:283-287. [PMID: 33639292 DOI: 10.1016/j.hansur.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
In literature, the use of gadolinium perfusion magnetic resonance imaging (GP-MRI) is recommended in Kienböck's disease to evaluate the lunate bone's perfusion. This survey study sought to assess how GP-MRI findings affect the management preferences of hand surgeons. A questionnaire consisting of 11 scenarios differing in ulnar variance, GP-MRI findings and management preferences was developed. The scenarios were designed based on the last published clinical guidelines. The questionnaire was sent to the members of a national hand surgery society consisting of 160 hand surgeons. Sixty-six surgeons completed the questionnaire. The surgeons' preferences changed significantly by ulnar variance in stages II and IIIA, and by GP-MRI in stages I and II. No need for other diagnostic tools was found in any of the scenarios. Management preferences of the study participants related to alterations in ulnar variance and treatment choices in all stages were in accordance with previously published clinical and survey studies. This study showed that GP-MRI findings significantly changed the management preferences of hand surgeons in early stages of Kienböck's disease. There was no significant tendency among the participants to use further assessment tools beyond direct radiography, MRI, and GP-MRI. Given the study results and the literature, we emphasize the limited and well-defined indications of GP-MRI in Kienböck's disease.
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Affiliation(s)
- K Güvenç
- Department of Hand Surgery, Eskişehir City Hospital, 71 Evler, Dedeoğlu Sk., 26080 Odunpazarı/Eskişehir, Turkey
| | - Z M Asfuroğlu
- University of Mersin, School of Medicine, Department of Orthopedics and Traumatology, Division of Hand Surgery, İhsaniye Mh., 32133 Sokak Çiftlikköy Kampüsü, 33079 Yenişehir/Mersin, Turkey
| | - C Yılmaz
- University of Mersin, School of Medicine, Department of Orthopedics and Traumatology, Division of Hand Surgery, İhsaniye Mh., 32133 Sokak Çiftlikköy Kampüsü, 33079 Yenişehir/Mersin, Turkey
| | - M M Eskandari
- University of Mersin, School of Medicine, Department of Orthopedics and Traumatology, Division of Hand Surgery, İhsaniye Mh., 32133 Sokak Çiftlikköy Kampüsü, 33079 Yenişehir/Mersin, Turkey.
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Lunate biomechanics: application to Kienböck's disease and its treatment. HAND SURGERY & REHABILITATION 2020; 40:117-125. [PMID: 33309792 DOI: 10.1016/j.hansur.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/20/2023]
Abstract
Kienböck's disease was initially considered as lunate osteomalacia due to lesions of its nutrient arteries during carpal ligament tears. It has also been suggested following primary fractures, or because of repeated microtrauma. It is only in the past 20 or 30 years that it has appeared as aseptic necrosis. Based on Hultén's hypothesis that a negative radioulnar index was the cause of Kienböck's disease, equalization osteotomies (shortening of the radius or lengthening of the ulna) were developed. The observation of Kienböck's disease in subjects with a positive index and the risk of ulnar abutment after osteotomy led to the introduction of new osteotomies to get around these difficulties, still in the hope of treating the cause of Kienböck's disease. While it has been confirmed that a negative radioulnar index promotes lunate fracture, it clearly does not induce the pathology in the form of necrosis. In this scenario, perilunar osteotomies produce durable decompression, limiting the risk of lunate fracture in case of necrosis by removing the compressive constraints. After comparing the different osteotomies used to treat Kienböck's disease, it seems that the Camembert osteotomy for radius shortening, combined with selective shortening of the ulnar head as described by Sennwald, decompresses the lunate maximally, and protects it long enough for potential natural revascularization to occur.
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Abstract
Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.
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Affiliation(s)
- Dana Rioux-Forker
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Aslantürk O, Ertem K, Ergen E, Köroğlu M. Extensor carpi radialis longus tendon ball interposition arthroplasty for treatment of late-stage Kienböck's disease: Short-term results of a novel technique. J Orthop Surg (Hong Kong) 2019; 26:2309499018802514. [PMID: 30270730 DOI: 10.1177/2309499018802514] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate short-term clinical and radiological results of extensor carpi radialis longus (ECRL) tendon ball arthroplasty for treatment of late-stage Kienböck's disease. METHODS We retrospectively reviewed data of 19 patients suffering from Kienböck's treated with ECRL tendon ball arthroplasty between December 2014 and December 2016. Patients' clinical functions were assessed using grip strength, range of motion (ROM) of the wrist, QuickDASH, Mayo wrist score, and visual analog scale score. Radiological examination was performed to assess carpal height ratio and progression of arthritis. RESULTS The median follow-up was 30 months (range, 12-36 months). At final follow-up, ROM of operated wrist was 71% of the nonoperated side. Thirteen (86.6%) patients were pain free. Carpal height ratio was statistically significantly reduced compared with preoperative values. All patients declared their satisfaction with the results due to their preoperative status. CONCLUSIONS ECRL tendon ball arthroplasty is a new and good option for treatment of late-stage Kienböck's disease with low complication rate.
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Affiliation(s)
- Okan Aslantürk
- 1 Department of Orthopedic and Trauma Surgery, Malatya Educational Research Hospital, Malatya, Turkey
| | - Kadir Ertem
- 2 Department of Orthopedic and Trauma Surgery, Inonu University Medicine Faculty, Malatya, Turkey
| | - Emre Ergen
- 2 Department of Orthopedic and Trauma Surgery, Inonu University Medicine Faculty, Malatya, Turkey
| | - Muhammed Köroğlu
- 2 Department of Orthopedic and Trauma Surgery, Inonu University Medicine Faculty, Malatya, Turkey
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Okubo H, Futenma C, Sunagawa H, Kinjo M, Kanaya F. Very Distal Radius Wedge Osteotomy for Kienböck's Disease: Case Series. J Hand Surg Asian Pac Vol 2019; 22:490-496. [PMID: 29117840 DOI: 10.1142/s0218810417500551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radius osteotomy is one of the standard surgical procedures for the treatment of Kienböck's disease. Unfortunately, radius osteotomy can result in an incongruous distal radio-ulnar joint (DRUj) postoperatively, because the procedure is performed proximal to the DRUj. METHODS A very distal radius wedge osteotomy was performed as a 15-degree lateral closing wedge osteotomy with the apex of the wedge distal to that of conventional lateral closing wedge osteotomy; this procedure was developed to avoid postoperative incongruous DRUj. We performed this procedure on 6 patients (stage III-A: 1, stage III-B: 5) with a mean age of 49 years. Clinical and radiographic evaluations were performed at a mean follow-up of 32 months. RESULTS Wrist pain disappeared in all patients. Mean grip strength improved from 35% to 87% of the contralateral side (p = 0.0255). Mean range of motion, measured as flexion-extension arc, improved from 93 to 128 degrees. Nakamura's score was good in all patient. Mean lunate covering ratio increased from 61% to 90% (p = 0.0151) and mean sigmoid notch inclination angle, a radiographic parameter of DRUj congruency, was not significantly different between pre-operative and final follow-up evaluation. No clinical or radiographic DRUj osteoarthritis findings were observed. CONCLUSIONS Our procedure of very distal radius wedge osteotomy provided satisfactory clinical results without an incongruous DRUj. This technique might prevent the occurrence of postoperative DRUj osteoarthritis.
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Affiliation(s)
- Hirotaka Okubo
- * Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Chojo Futenma
- * Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideyuki Sunagawa
- † Department of Orthopedic Surgery, Nanbu Tokushukai Hospital, Okinawa, Japan
| | - Masaki Kinjo
- * Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Fuminori Kanaya
- * Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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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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Laravine J, Loubersac T, Gaisne E, Bellemère P. Evaluation of a shape memory staple (Qual ®) in radial shortening osteotomy in Kienböck's disease: A retrospective study of 30 cases. HAND SURGERY & REHABILITATION 2019; 38:141-149. [PMID: 30802604 DOI: 10.1016/j.hansur.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/27/2022]
Abstract
The QUAL® (Memometal, Stryker) device is a shape memory staple used for bone fixation during distal radius shortening osteotomy in the context of Kienböck's disease. The present study is a retrospective, single-center and multisurgeon study of 30 patients with a mean follow-up of 8 years. Clinical criteria (range of motion (ROM), strength, pain and functional score) and radiographic data (ulnar variance, distal radius articular surface inclination, Lichtman stage, carpal height and bone healing) were evaluated pre- and post-operatively. We found satisfactory results with the mean grip strength of 22 kg/F before surgery and 24 kg/F after surgery. The mean ROM was 88° preoperatively and 82° postoperatively and the mean ulnar deviation was 23° preoperatively and 21° post-operatively. There was no change in radial deviation and pronation-supination after surgery. The average ulnar variance was 1 mm before surgery and 0.2 mm after surgery. The inclination of the distal radius articular surface on lateral and anteroposterior views and the mean carpal height were similar to the pre-operative ones. There was no delay in bone healing. The mean pain score was 2 at rest on a visual analogue scale after surgery. Seven patients experienced an increase in their Lichtman stage at the follow-up, and two patients were waiting for conversion to a non-conservative surgical treatment. Seven staples were removed postoperatively. Seventy-eight percent of patients returned to work after 3 months on average. Seventy-five percent of patients were at least satisfied with the outcome of their surgery. The QUAL® staple is a reliable option for fixation during shortening osteotomy of the radius in Kienböck's disease.
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Affiliation(s)
- J Laravine
- Centre des Pathologies Ostéarticulaires, 95, avenue Raymond Barre, 97430 Le Tampon, Reunion
| | - T Loubersac
- Institut de la Main Nantes-Atlantique, Santé Atlantique groupe Elsan, boulevard Paul-Gauthier, 44800 Saint-Herblain, France
| | - E Gaisne
- Institut de la Main Nantes-Atlantique, Santé Atlantique groupe Elsan, boulevard Paul-Gauthier, 44800 Saint-Herblain, France
| | - P Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique groupe Elsan, boulevard Paul-Gauthier, 44800 Saint-Herblain, France
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Shin YH, Kim JK, Han M, Lee TK, Yoon JO. Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review. J Bone Joint Surg Am 2018; 100:1231-1240. [PMID: 30020130 DOI: 10.2106/jbjs.17.00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease. METHODS We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies. RESULTS Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°). CONCLUSIONS Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young Ho Shin
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Kwang Kim
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minkyu Han
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Kyoon Lee
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun O Yoon
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Luegmair M, Goehtz F, Kalb K, Cip J, van Schoonhoven J. Radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease. J Hand Surg Eur Vol 2017; 42:253-259. [PMID: 28196441 DOI: 10.1177/1753193416676723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We carried out a retrospective study to analyse the long-term outcome of 36 patients after radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease at a mean follow-up of 12.1 years (range 5.4-17.5). At review, seven wrists had progressed to Stage IIIB, eight wrists to Stage IV and 21 remained in Stage IIIA. Motion and grip strength were significantly improved. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score at review was 12 points (range 0-52), and patient satisfaction was high. Apart from plate removals in 14 patients and one wrist denervation, no subsequent surgical procedures were done. Radial shortening yields good long-term clinical results, but does not prevent radiographic progression of disease in some patients. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- M Luegmair
- 1 Department of Orthopaedic Surgery, Medical University of Innsbruck, Zams, Austria
| | - F Goehtz
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
| | - K Kalb
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
| | - J Cip
- 3 Department of Orthopaedic Surgery, Medical University of Innsbruck, Feldkirch, Austria
| | - J van Schoonhoven
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
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15
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Tatebe M, Koh S, Hirata H. Long-Term Outcomes of Radial Osteotomy for the Treatment of Kienböck Disease. J Wrist Surg 2016; 5:92-97. [PMID: 27104072 PMCID: PMC4838469 DOI: 10.1055/s-0036-1581099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
Background Kienböck disease is an aseptic necrosis of the lunate of unknown etiology, prevalent in young adults. Treatment aims to lower forces on the lunate, decrease pain and improve function. We conducted a retrospective evaluation of the 10-year clinical and radiological outcomes of radial osteotomy as a treatment for Kienböck disease. Materials and Methods We analyzed pain, grip strength, wrist range of motion (ROM), radiological carpal geometry, and staging of osteoarthritic changes over a 10-year period, postosteotomy, for 18 patients. The Mayo wrist score was used as an overall measure of outcome. Technique Outcomes for two types of osteotomies were included, a step-cut osteotomy with fixed screws and an updated technique of two linear transverse osteotomies with volar locking plates. For cases with negative ulnar variance, resection of the radius was included to obtain a final ulnar variance of -1 to 0 mm. For positive ulnar variance, the goal was to obtain a correction of radial inclination of 10 to 15 degrees. Results Improvements in pain, ROM, and grip strength were maintained over the 10-year follow-up, without radiological improvement in geometry (carpal height ratio and Stahl index). Mild osteoarthritic changes were identified in 33% of patients, with no effect on clinical results. Degree of cartilage damage determined postoperative grip strength improvement. The Mayo wrist score at the final follow-up was excellent in one patient, good in nine, and fair in eight. Conclusions Radial osteotomy provides reasonable and long-term clinical benefits. Preoperative arthroscopic evaluation of cartilage damage can inform treatment decisions.
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Affiliation(s)
- Masahiro Tatebe
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Sukuki Koh
- Hand Department, Japanese Red Cross Hospital Nagoya Daiichi, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
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16
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Viljakka T, Tallroth K, Vastamäki M. Long-Term Natural Outcome (7–26 Years) of Lichtman Stage III Kienböck’s Lunatomalacia. Scand J Surg 2015; 105:125-32. [DOI: 10.1177/1457496915577023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
Background and Aims: The natural history of Kienböck’s disease is controversial. Only three papers report a pure natural history without treatment. We hypothesized that the natural course of Kienböck’s disease may be better than reported. Material and Methods: We examined eight patients with Lichtman stage III Kienböck’s disease without any treatment, evaluating clinical and radiological results (9 wrists; 7 men, mean age at onset of symptoms 34 years) over a period of 10–38 years (mean, 27.3 years) after symptom onset. Results: Lichtman stage remained the same in five of nine wrists. The inner structure of the lunate improved in three, remained the same in three, and deteriorated in three wrists, and its shape improved in two, remained the same in four, and deteriorated in three wrists. Pain averaged visual analog scale 3.1 at rest, 3.4 during motion, 3.6 with slight, and 5.2 with heavy exertion. The range of motion improved at extension 19% and at flexion 14%, reaching 81% and 72% of that of the contralateral wrist, and grip strength reaching 93%. The Disabilities of the Arm, Shoulder, and Hand averaged 11.3, Optional Disabilities of the Arm, Shoulder, and Hand 18.0, and Mayo Clinic score 70.0. The radiographic course did not correlate with clinical course. Conclusions: The long-term natural history of Lichtman stage III Kienböck’s disease is insufficiently good to suggest thoughtful observation alone as an option to treat it.
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Affiliation(s)
- T. Viljakka
- ORTON Research Institute and ORTON Hospital, Invalid Foundation, Helsinki, Finland
| | - K. Tallroth
- ORTON Research Institute and ORTON Hospital, Invalid Foundation, Helsinki, Finland
| | - M. Vastamäki
- ORTON Research Institute and ORTON Hospital, Invalid Foundation, Helsinki, Finland
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17
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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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18
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Clinical Outcomes of Radial Shortening Osteotomy and Vascularized Bone Graft in Kienböck's Disease. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:956369. [PMID: 27382615 PMCID: PMC4897411 DOI: 10.1155/2014/956369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to compare two surgery methods including radial shortening and radial shortening combined with vascularized bone graft for treatment of stage II or IIIa of Kienböck's disease. It is a randomized, controlled clinical trial, which was carried out in 2011–2013. Twenty-four patients were assigned equally to radial shortening group (A) or radial shortening combined with vascularized bone graft group (B). The outcome was assessed by Mayo Wrist score before and 9 months after surgery. The mean Mayo Wrist score (SD) was 27.1 (15.4) and 32.5 (18.3) before surgery and 74.6 (5.4) and 85.8 (5.1) after surgery for groups A and B, respectively. The mean score increased in both groups, and it was higher in group B significantly. Radial shortening combined with vascularized bone graft is a valuable method which can be more effective than radial shortening alone, in early stages of Kienböck's disease. This trial is registered with IRCT201404127841N5.
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Fouly EH, Sadek AF, Amin MF. Distal capitate shortening with capitometacarpal fusion for management of the early stages of Kienböck's disease with neutral ulnar variance: case series. J Orthop Surg Res 2014; 9:86. [PMID: 25304759 PMCID: PMC4195980 DOI: 10.1186/s13018-014-0086-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background The aim of surgical management of Kienböck’s disease has been proposed to slow the progressive osteonecrosis and secondary carpal damage. The aim of this case series was to evaluate the results of a new technique, combining distal capitate shortening with capitometacarpal fusion for the treatment of Kienböck’s disease (Lichtman stage II or stage IIIA) in neutral ulnar variance patients. Methods From 2009 to 2012, 12 patients (mean age: 25 ± 7.6 years) were enrolled in this series. Radiological and clinical evaluations using the modified Mayo wrist scoring system were performed both pre-operatively and 12 months post-operatively. In addition, values of the scapho-capitate angle were evaluated both pre-operatively and 12 months post-operatively. The mean follow-up was 20.7 ± 11.2 months. Statistical analysis was performed for comparisons between pre-operative and post-operative findings with the use of paired sample T test, Pearson’s correlation, independent sample T test, and Spearman’s rho correlation. Statistical significance was determined to be present at p <0.05. Results All patients achieved bony union at the fusion site within a mean period of 11.5 ± 2.4 weeks. Regarding wrist pain, grip strength, total wrist arc of motion, practicing daily activities in a normal pattern, and the total modified Mayo wrist score, there were statistically significant differences between the pre-operative and post-operative results. For the differential arc of motion, the only non-significant results were at the ulnar/radial deviation range (p = 0.262). The mean pre-operative scapho-capitate angle was 29.75 ± 3.44 while the mean post-operative value was 33.67 ± 4.77 (p < 0.001). Both pre-operative and post-operative scapho-capitate angle values were positively correlated to post-operative pain, ulnar/radial deviation, and final score (p = 0.001, 0.027, 0.021 and p = 0.001, 0.004, 0.002, respectively). Other parameters had no correlation to this angle. Post-operative MRI (at 12 months follow-up) demonstrated better lunate revascularization in four patients; one of them was diagnosed as having Lichtman stage IIIA Kienböck’s disease. There were no patient-reported complications at the end of follow-up. Conclusions Distal capitate shortening combined with capitometacarpal fusion represents a new reliable method in the treatment of early stages of Kienböck’s disease with neutral ulnar variance.
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Viljakka T, Tallroth K, Vastamäki M. Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck's lunatomalacia. J Hand Surg Eur Vol 2014; 39:761-9. [PMID: 24300510 DOI: 10.1177/1753193413512222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radial shortening osteotomy (RSO) as treatment for Kienböck's disease usually improves patient symptoms for several years. Four small series have also shown that the effect may last for decades, but only two studies have used a patient-based assessment. We examined 16 patients, with a mean age at operation of 32 years, evaluating clinical and radiological results at a mean 25 (range 20 to 33) years after surgery. Three patients had progressive lunate collapse, of whom one patient needed a silicone implant arthroplasty 2 years after RSO and one patient a wrist fusion 16 years after RSO. The time between onset of symptoms and osteotomy in the remaining 14 patients averaged 20 months. The mean VAS for pain was 0.9 at rest, 0.9 with unloaded motion, 1.7 with slight, and 3.0 with heavy exertion. Two patients had marked wrist pain. Compared with the contralateral wrist the mean range of motion was 88%, grip strength was 95%, and key pinch 107%. The Disabilities of the Arm, Shoulder, and Hand score averaged 6.1, and the Mayo wrist score, 79.3. The Lichtman stage remained unchanged in 56% of patients. The inner structure of the lunate improved in all patients, and its shape remained unchanged in half of the cases. Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck's disease.
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Affiliation(s)
- T Viljakka
- ORTON Research Institute and ORTON Orthopaedic Hospital, Helsinki, Finland
| | - K Tallroth
- ORTON Research Institute and ORTON Orthopaedic Hospital, Helsinki, Finland
| | - M Vastamäki
- ORTON Research Institute and ORTON Orthopaedic Hospital, Helsinki, Finland
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21
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Outcomes assessment of lunate replacement arthroplasty with intrinsic carpal ligament reconstruction in Kienböck's disease. Hand (N Y) 2014; 9:364-9. [PMID: 25191169 PMCID: PMC4152445 DOI: 10.1007/s11552-014-9624-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND With advanced Kienböck's disease, hyaline cartilage delamination or bone fragmentation render the lunate unsalvageable. Common surgical options are proximal row carpectomy, scaphotrapeziotrapezoid fusion, scaphocapitate fusion, or total wrist fusion. The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of one alternative: lunate prosthetic replacement arthroplasty combined with reconstruction of the scapholunate and lunotriquetral interosseous ligaments using the flexor carpi radialis tendon. METHODS Eligible patients with advanced Kienböck's disease and an unsalvageable lunate were included in this prospective study on a self-selected basis, forming a study group of 13 consecutive patients, 6 males and 7 females with a mean age of 40. Clinical and radiographic measurements were compared at a mean follow-up of 30.3 months from surgery with a paired, single-tailed, Student's t test using a p value of 0.05 as statistically significant. RESULTS Mean preoperative/postoperative clinical measurements were as follows: wrist flexion 29.2°/43.3°, wrist extension 24.2°/53.3°, absolute value grip strength 12.3/31.5 kg, grip strength vs. contralateral 36.5/85.2 %, and DASH scores 39.1/7.7. Mean initial/immediate postoperative/final radiographic measurements were the following: scapholunate angle 64.2°/46.7°/46.4°, radioscaphoid angle 64.6°/42.1°/45°, and modified carpal height ratio 1.20/1.62/1.59. Preoperative to postoperative differences were all statistically significant. CONCLUSIONS Although these subjective and objective results reflect substantial improvement, there remain recognizable deficiencies in both prosthetic design and surgical strategy that require further modification.
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22
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Matsui Y, Funakoshi T, Motomiya M, Urita A, Minami M, Iwasaki N. Radial shortening osteotomy for Kienböck disease: minimum 10-year follow-up. J Hand Surg Am 2014; 39:679-85. [PMID: 24612833 DOI: 10.1016/j.jhsa.2014.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/01/2014] [Accepted: 01/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To clarify long-term clinical and radiological results more than 10 years after radial shortening osteotomy for Kienböck disease. METHODS Eleven wrists of 10 patients that had been classified as Lichtman stages 3A (2 wrists), 3B (8 wrists), and 4 (1 wrist) underwent radial shortening for Kienböck disease. The mean follow-up period was 14.3 years (range, 10-21 y). Clinical outcomes were quantified using the Japanese version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and the modified Mayo wrist score. Radiographic and magnetic resonance imaging studies were performed for 9 of the 10 patients preoperatively and all 10 patients at follow-up. RESULTS At follow-up, 6 wrists were asymptomatic and the remaining 5 had mild occasional pain. The mean range of extension and grip strength significantly improved. The mean modified Mayo wrist score and Disabilities of the Arm, Shoulder, and Hand scores were 92 (range, 80-100) and 5 (range, 0-18), respectively. At follow-up, no progression of the Lichtman stage was found in any patient. There was no significant progressive lunate collapse in any patient. The magnetic resonance imaging in 7 wrists showed increased signal intensity of the lunate; the remaining 3 wrists had no alteration in signal intensity of the bone. CONCLUSIONS Our study demonstrated satisfactory clinical results after 10 or more years in patients who underwent radial shortening for Kienböck disease. Although we found no improvement in signal intensity of the lunate in 3 wrists, unloading of the diseased lunate after radial shortening gives long-lasting symptom relief and may prevent lunate collapse. TYPE OF STUDY/LEVEL OF DISEASE Therapeutic IV.
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Affiliation(s)
- Yuichiro Matsui
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan
| | - Michio Minami
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan.
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23
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Werber KD, Schmelz R, Peimer CA, Wagenpfeil S, Machens HG, Lohmeyer JA. Biomechanical effect of isolated capitate shortening in Kienbock's disease: an anatomical study. J Hand Surg Eur Vol 2013; 38:500-7. [PMID: 22918882 DOI: 10.1177/1753193412458996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple operations have been proposed to slow the progression of osteonecrosis and secondary carpal damage in Kienböck's disease. To assess the biomechanical changes after capitate shorting, we inserted pressure-testing devices into the carpal and radiocarpal joints in an anatomical study. Pressure sensors were placed into eight thawed non-fixated human cadaver arms to measure the forces transmitted in physiological loading. Longitudinal 9.8 N and 19.6 N forces were applied before and after capitate shortening. After capitate shortening, significant load reduction on the lunate was evident in all specimens. An average decrease of 49% was seen under a 9.8 N load and 56% under a 19.6 N load. The load was transferred to the radial and ulnar intercarpal joints. More relief of pressure on the lunate after isolated capitate shortening is achieved with a shallow angle between the scaphoid and capitate in the posteroanterior radiograph.
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Affiliation(s)
- K-D Werber
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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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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25
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Blanco RH, Blanco FR. Osteotomy of the radius without shortening for Kienböck disease: a 10-year follow-up. J Hand Surg Am 2012; 37:2221-5. [PMID: 22995698 DOI: 10.1016/j.jhsa.2012.07.023] [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: 08/30/2011] [Revised: 07/22/2012] [Accepted: 07/26/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the long-term effect of distal radius osteotomy without modifying the radial length or inclination for Kienböck disease. METHODS Over 9 years, 14 patients underwent osteotomy of the distal radius without altering radial length or inclination. A total of 11 of these patients were available for follow-up after 10 or more years. We assessed pain, range of wrist motion, and grip strength preoperatively and postoperatively in all cases, as well as preoperative and postoperative posteroanterior and lateral x-rays. RESULTS The osteotomy healed in all cases. All 11 patients had decreased pain and showed improvement in wrist motion and grip strength. Radiographically, there were no measurable changes in ulnar variance and there was minimal loss of carpal height. In some patients, the lunate showed increased sclerosis or fragmentation. CONCLUSIONS An osteotomy of the distal radius without altering radial length or inclination was effective in decreasing pain and improving grip strength and wrist motion regardless of ulnar variance.
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Affiliation(s)
- Roque H Blanco
- Department of Hand Surgery, Clínica Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
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26
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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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27
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Rodrigues-Pinto R, Freitas D, Costa LD, Sousa R, Trigueiros M, Lemos R, Silva C, Oliveira A. Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease. ACTA ACUST UNITED AC 2012; 94:222-6. [DOI: 10.1302/0301-620x.94b2.27729] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radial osteotomy is currently advocated for patients with Lichtman’s stages II and IIIA of Kienböck’s disease; its place in the treatment of patients with stage IIIB disease remains controversial. The purpose of this study was to evaluate the medium-term results of this procedure and to compare the outcome in patients with stage IIIB disease and those with earlier stages (II and IIIA). A total of 18 patients (18 osteotomies) were evaluated both clinically and radiologically at a mean follow-up of 10.3 years (4 to 18). Range of movement, grip strength and pain improved significantly in all patients; the functional score (Nakamura Scoring System (NSSK)) was high and self-reported disability (Disabilities of Arm, Shoulder and Hand questionnaire) was low at the final follow-up in all patients evaluated. Patients with stage IIIB disease, however, had a significantly lower grip strength, lower NSSK scores and higher disability than those in less advanced stages. Radiological progression of the disease was not noted in either group, despite the stage. Radial osteotomy seems effective in halting the progression of disease and improving symptoms in stages II, IIIA and IIIB. Patients with less advanced disease should be expected to have better clinical results.
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Affiliation(s)
- R. Rodrigues-Pinto
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - D. Freitas
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - L. D. Costa
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - R. Sousa
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - M. Trigueiros
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - R. Lemos
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - C. Silva
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
| | - A. Oliveira
- Centro Hospitalar do Porto – Hospital
de Santo António, Department of Orthopaedics, Largo
Prof. Abel Salazar, Porto 4099-001, Portugal
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Abstract
PURPOSE Kienböck's disease affects the lunate bone, and osteoarthritic changes progress as the disease advances; however, relatively few studies have reported the arthroscopic findings of Kienböck's disease, and these reports have been in small populations. The purpose of this study was to review arthroscopic findings in a larger population than studied in previous reports. METHODS We retrospectively reviewed 57 patients who underwent radial osteotomy for Kienböck's disease after arthroscopy of both the radiocarpal and midcarpal joints. All arthroscopic findings were classified as follows in terms of the location of osteoarthritic changes: lunate fossa of the radius, proximal/distal surface of the lunate bone, and capitate head. Radiological stages were classified according to the modified Lichtman's classification system. RESULTS All but two patients had cartilage lesions in the proximal lunate cartilage. Older patients had significantly more cartilage lesions, but radiological stage showed no correlation with the number of cartilage lesions. CONCLUSIONS This study demonstrated that the proximal lunate bone was affected in most cases of Kienböck's disease and that older patients had more cartilage lesions.
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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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Innes L, Strauch RJ. Systematic review of the treatment of Kienböck's disease in its early and late stages. J Hand Surg Am 2010; 35:713-7, 717.e1-4. [PMID: 20438990 DOI: 10.1016/j.jhsa.2010.02.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 01/18/2010] [Accepted: 02/02/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of the treatment of Kienböck's disease to test the hypothesis that none of the reported treatments for Kienböck's disease is superior with respect to outcomes of pain, motion, grip strength, and radiographic measures. METHODS We searched PubMed, Medline, and the Cochrane Review for articles published between 1998 and 2008 reporting outcomes of treatment for Kienböck's disease. Patients were grouped by stage of disease. Early stages were defined as Lichtman stage I, II, and IIIa, and 'late' stages as IIIb and IV. The groups were then analyzed on the basis of treatment; procedures performed on subjects in the early group included vascularized bone grafting (VBG), metaphyseal core decompression, and radial osteotomy, whereas the procedures performed on subjects in the late group included VBG, radial osteotomy, partial arthrodesis, proximal row carpectomy, tendon ball arthroplasty, and nonsurgical treatment. RESULTS We found no statistically significant difference between any of the treatment groups for subjective pain outcomes. In terms of objective measures, statistically significant improvement (p<.05) was seen in range of motion after radial osteotomy and VBG in early-stage patients and after all interventions, except partial arthrodesis and nonsurgical treatment, for late-stage patients. Grip strength was significantly improved in early-stage patients after radial osteotomy and VBG and for all late-stage patients, except among those managed nonsurgically. Changes in Stahl and carpal height index scores were not statistically significant regardless of intervention, except after radial osteotomy in the early group, where they statistically worsened. CONCLUSIONS Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease and there are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease.
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Affiliation(s)
- Lindsay Innes
- Department of Orthopaedics, Columbia University, New York, NY, USA
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Takahara M, Watanabe T, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. Surgical technique. J Bone Joint Surg Am 2009; 91 Suppl 2:184-90. [PMID: 19805582 DOI: 10.2106/jbjs.i.00315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three previous studies have investigated the long-term outcome of radial osteotomy in the treatment of Kienböck disease. However, none used patient-based assessment. The purpose of this study was to investigate the long-term clinical and radiographic outcomes of this osteotomy, including the subjective evaluation of the patient with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. METHODS A DASH questionnaire was sent to nineteen patients with Kienböck disease who had undergone a radial shortening osteotomy, and thirteen replied. The mean age at the time of surgery was thirty-nine years. On the basis of the Lichtman classification, six patients had stage-II, four had stage-IIIA, and three had stage-IIIB disease. Prior to surgery, ulnar variance was positive in six patients, neutral in four, and negative in three. The mean duration of follow-up was twenty-one years. Clinical evaluation, including calculation of the modified Mayo wrist score, and radiographic evaluation were also performed on twelve of the thirteen patients. RESULTS The mean DASH score was 8 points (range, 0 to 23 points), and patient satisfaction was high. Compared with the findings in the contralateral wrist, the mean range of motion was 81% in flexion and 82% in extension and mean grip strength was 88%. The mean modified Mayo wrist score was 83 points, and the clinical results were excellent in six patients, good in five, and moderate in one. The DASH scores tended to be worse in patients with Lichtman stage-IIIB disease. Follow-up radiographs revealed that the Lichtman stage had progressed in six of the twelve patients. CONCLUSIONS Although most patients had mild wrist pain, patient satisfaction and the clinical results were satisfactory following a radial shortening osteotomy. This procedure is a reliable long-term treatment for Lichtman stage-II and IIIA disease and may be a reasonable option for patients with stage-IIIB disease.
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Affiliation(s)
- Masatoshi Takahara
- Department of Orthopaedic Surgery, Yamagata University School of Medicine, Yamagata, Japan.
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Waitayawinyu T, Chin SH, Luria S, Trumble TE. Capitate shortening osteotomy with vascularized bone grafting for the treatment of Kienböck's disease in the ulnar positive wrist. J Hand Surg Am 2008; 33:1267-73. [PMID: 18929187 DOI: 10.1016/j.jhsa.2008.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 04/02/2008] [Accepted: 04/10/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Decompression surgery combined with revascularization surgery may provide better results than either alone in the treatment of Kienböck's disease. This study describes our experience with capitate shortening combined with vascularized bone grafting for the treatment of Kienböck's disease in ulnar neutral and ulnar positive variant patients. METHODS Between 1996 and 2004, patients diagnosed with Lichtman stage II or stage IIIA Kienböck's disease with ulnar neutral or ulnar positive wrists were enrolled in this prospective study and had capitate shortening osteotomy with concurrent vascularized bone grafting. Preoperative and postoperative clinical evaluation included wrist arc of motion, grip strength, and overall satisfaction score. Preoperative and postoperative wrist radiographs and preoperative magnetic resonance imaging were performed. Radiographic measurements of preoperative and postoperative ulnar variance and carpal height ratio were also evaluated. The average follow-up period was 41 months (range, 26-65 months). RESULTS Fourteen patients with an average age of 25 years (range, 16-39 years) were studied. The results show significant improvement in grip strength (58% to 78% of the normal side), satisfaction score, and satisfactory arc of motion. The average carpal height ratio was maintained. Average time to osteotomy healing was 48 days. CONCLUSIONS Capitate shortening osteotomy combined with vascularized bone graft is effective in the treatment of ulnar-positive Kienböck's disease prior to the onset of radiocarpal arthrosis.
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Affiliation(s)
- Thanapong Waitayawinyu
- Department of Orthopaedics and Sports Medicine, University of Washington Hand Center, University of Washington, Seattle, WA 98195, USA
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Abstract
Kienböck's disease (carpal lunate necrosis or lunatomalacia) is the most common aseptic osteonecrosis of the upper extremity. Other bone necroses in the hand occur less frequently. The name indicates a disease with unclear etiology which eventually always leads to necrosis of the lunate bone. It usually affects the dominant hands of males between 20 and 40 years of age. Treatment methods extend from immobilization to revascularization surgery on the affected bone. There is still no gold standard for the treatment of Kienböck's disease.
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35
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Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. J Bone Joint Surg Am 2008; 90:1705-11. [PMID: 18676901 DOI: 10.2106/jbjs.g.00421] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three previous studies have investigated the long-term outcome of radial osteotomy in the treatment of Kienböck disease. However, none used patient-based assessment. The purpose of this study was to investigate the long-term clinical and radiographic outcomes of this osteotomy, including the subjective evaluation of the patient with use of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. METHODS A DASH questionnaire was sent to nineteen patients with Kienböck disease who had undergone a radial shortening osteotomy, and thirteen replied. The mean age at the time of surgery was thirty-nine years. On the basis of the Lichtman classification, six patients had stage-II, four had stage-IIIA, and three had stage-IIIB disease. Prior to surgery, ulnar variance was positive in six patients, neutral in four, and negative in three. The mean duration of follow-up was twenty-one years. Clinical evaluation, including calculation of the modified Mayo wrist score, and radiographic evaluation were also performed on twelve of the thirteen patients. RESULTS The mean DASH score was 8 points (range, 0 to 23 points), and patient satisfaction was high. Compared with the findings in the contralateral wrist, the mean range of motion was 81% in flexion and 82% in extension and mean grip strength was 88%. The mean modified Mayo wrist score was 83 points, and the clinical results were excellent in six patients, good in five, and moderate in one. The DASH scores tended to be worse in patients with Lichtman stage-IIIB disease. Follow-up radiographs revealed that the Lichtman stage had progressed in six of the twelve patients. CONCLUSIONS Although most patients had mild wrist pain, patient satisfaction and the clinical results were satisfactory following a radial shortening osteotomy. This procedure is a reliable long-term treatment for Lichtman stage-II and IIIA disease and may be a reasonable option for patients with stage-IIIB disease.
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Affiliation(s)
- Tadayoshi Watanabe
- Department of Orthopaedic Surgery, Yamagata University School of Medicine, Iida-Nishi 2-2-2, Yamagata 990-9585, Japan
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Tatebe M, Horii E, Majima M, Koh S, Nakamura R, Hirata H. Radial osteotomy for Kienböck's disease with displaced fracture of the lunate. J Hand Surg Am 2007; 32:1343-7. [PMID: 17996767 DOI: 10.1016/j.jhsa.2007.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 08/07/2007] [Accepted: 08/17/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Advanced Kienböck's disease often involves displaced fractures of the lunate; however, whether such fractures affect surgical outcomes remains unclear. The purpose of this study was to evaluate the results of radial osteotomy for Kienböck's disease with displaced fractures of the lunate and whether these fractures would achieve union. METHODS We reviewed patients who had radial osteotomy for Kienböck's disease between 1975 and 2004. We included only displaced fractures of the lunate that were apparent on lateral radiography, and 31 patients (24 men, 7 women; mean age, 35 y) were then included in this study. Postoperative state of the lunate and clinical results were compared between cases of union and nonunion. RESULTS Preoperatively, mean flexion/extension arc was 76 degrees , and mean grip strength was 22 kg. Postoperatively, mean flexion/extension arc was 84 degrees , and mean grip strength was 30 kg. Radiography revealed fracture healing in 16 wrists. No significant differences between union and nonunion were noted in any assessed clinical items. CONCLUSIONS This study showed approximately 50% union after radial osteotomy. Fracture union did not affect clinical results. Clinical results were good considering the advanced stage of Kienböck's disease. Even with displaced fractures of the lunate, radial osteotomy yields results comparable with other treatments for same-stage patients and thus represents a reasonable approach.
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Affiliation(s)
- Masahiro Tatebe
- Department of Hand Surgery, Nagoya University School of Medicine, Showaku, Nagoya, Japan.
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Herdem M, Ozkan C, Bayram H. Overgrowth after radial shortening for Kienböck's disease in a teenager: case report. J Hand Surg Am 2006; 31:1322-5. [PMID: 17027794 DOI: 10.1016/j.jhsa.2006.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/18/2006] [Accepted: 07/24/2006] [Indexed: 02/02/2023]
Abstract
A 16-year-old boy was treated by a radial-shortening procedure for symptomatic stage IIIB Kienböck's disease with 4 mm negative ulnar variance. The osteotomy corrected the ulnar variance to negative 1 mm after surgery, but further negative ulnar variance of 9 mm occurred at follow-up evaluation as a result of radial overgrowth. The functional outcome was excellent with remodeling of the lunate. The possibility of overgrowth should be considered when contemplating a radial-shortening osteotomy for Kienböck's disease in skeletally immature patients.
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Affiliation(s)
- Mustafa Herdem
- Department of Orthopaedics and Traumatology, Cukurova University Faculty of Medicine, Balcali, Adana, Turkey
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Van den Dungen S, Dury M, Foucher G, Marin Braun F, Loréa P. Conservative treatment versus scaphotrapeziotrapezoid arthrodesis for Kienbock's disease. A retrospective study. ACTA ACUST UNITED AC 2006; 25:141-5. [PMID: 17175800 DOI: 10.1016/j.main.2006.07.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Efficiency of surgical treatment in Kienböck's disease has never been proven in the long term. We retrospectively reviewed the charts of the 104 patients treated by various techniques for Kienböck's disease from 1981 to 1999 in our unit. A comparison was made between 19 cases treated conservatively (amongst 59) and 11 cases (amongst 25) treated by scaphotrapeziotrapezoid (STT) arthrodesis with a mean follow-up of 13 years. The two groups were statistically comparable in stage, age, sex ratio, number of manual workers. STT arthrodesis was responsible for an increased loss of mobility, an increase of barometric pain, a longer rehabilitation time and more fractures of lunatum than conservative treatment. Those results question about indications for STT in Kienböck's disease.
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Affiliation(s)
- S Van den Dungen
- Department de chirurgie orthopédique, hôpital Erasmus, cliniques universitaires de Bruxelles, route de Lennik, 1070 Bruxelles, Belgique.
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