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Saeki M, Yoneda H, Yamamoto M. Clinical and radiographic results of lunate resection and vascularized os pisiform transfer for Kienböck's disease. JPRAS Open 2024; 39:132-141. [PMID: 38259863 PMCID: PMC10801120 DOI: 10.1016/j.jpra.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 01/24/2024] Open
Abstract
Although various treatments for advanced stages of Kienböck's disease have been reported, clinical evidence demonstrating the efficacy of lunate resection and vascularized os pisiform transfer for Kienböck's disease is limited. Herein, we investigated the clinical and radiographic results of this procedure. We retrospectively investigated eight patients who were followed up for ≥1 year. The mean age at the time of surgery was 52 years. The mean follow-up period was 3.4 years. The preoperative and postoperative mean wrist flexion-extension ranges were 84° and 111°, respectively, and grip strengths were 18.5 and 26.3 kg, respectively. Pain decreased in five patients postoperatively. The mean preoperative and postoperative carpal height ratios were 0.47 and 0.46, respectively, and radio scaphoid angles were 63° and 65°, respectively. Osteoarthritic changes were observed in or around the transferred pisiform in all five patients who were surveyed using radiographs. Most patients demonstrated satisfactory clinical results, including pain relief and improved wrist motion and grip strength, regardless of osteoarthritic wrist changes on postoperative radiographs. In summary, this procedure was effective for treating Kienböck's disease, especially in the advanced stages. Level of evidence: Ⅳ.
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Affiliation(s)
- Masaomi Saeki
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Bae JY, Shin YH, Choi SW, Moon SH, Park HS, Kim JK. A novel classification of Kienbock's disease based on magnetic resonance imaging. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05861-3. [PMID: 37300563 DOI: 10.1007/s00264-023-05861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We devised a classification system for Kienbock's disease using magnetic resonance imaging (MRI). Moreover, we compared it with the modified Lichtman classification and evaluated the inter-observer reliability. METHODS Eighty-eight patients diagnosed with Kienbock's disease were included. All patients were classified using the modified Lichtman and MRI classifications. MRI staging was based on factors including partial marrow oedema, cortical integrity of the lunate, and dorsal subluxation of the scaphoid. The inter-observer reliability was evaluated. We also evaluated the presence of a displaced coronal fracture of the lunate and investigated its association with the presence of a dorsal subluxation of the scaphoid. RESULTS Seven patients were categorized into stage I, 13 into II, 33 into IIIA, 33 into IIIB, and two into IV using the modified Lichtman classification. Six patients were categorized into stage I, 12 into II, 56 into IIIA, ten into IIIB, and four into IV using the MRI classification. The greatest shift between the stages was observed in stages IIIA and IIIB when the results of the two classification systems were compared. The inter-observer reliability of the MRI classification was greater than that of the modified Lichtman classification. Fifteen cases with a displaced coronal fracture of the lunate were identified, and a dorsal subluxation of the scaphoid was significantly more present in these patients. CONCLUSION The MRI classification system is more reliable than is the modified Lichtman classification. MRI classification reflects carpal misalignment with higher fidelity and is more appropriate for classification into stages IIIA and IIIB.
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Affiliation(s)
- Joo-Yul Bae
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-Si, Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic Road 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Shin Woo Choi
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-Si, Korea
| | - Sung Ho Moon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic Road 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Ha Sung Park
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-Si, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic Road 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
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Saremi H, Shiruei S, Moradi A. Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression. J Hand Surg Am 2023:S0363-5023(23)00114-4. [PMID: 36973101 DOI: 10.1016/j.jhsa.2023.02.011] [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: 10/26/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE This study evaluated the mid-term functional and radiological results of arthroscopic lunate core decompression for treating Kienböck disease. METHODS In a prospective cohort study, 40 patients with a confirmed diagnosis of Kienböck disease (Lichtman stages II to IIIb) underwent arthroscopic core decompression of the lunate bone. A cutting bur was used through the trans-4 portal with visualization from the 3-4 portal after synovectomy and debridement of radiocarpal joint using a shaver from the 6R portal. Disabilities of Arm, Shoulder, and Hand and visual analog scale scores, wrist range of motion, grip strength, radiological changes of Lichtman classification, carpal height ratio, and scapholunate angle were evaluated before and two years after the surgery. RESULTS The mean of Disabilities of Arm, Shoulder, and Hand score improved from 52.5 ± 13 to 29.2 ± 16.3. The visual analog scale score also improved from 7.6 ± 1.8 to 2.7 ± 1.9. There was also an improvement in hand grip strength from 6.6 ± 2.7 kg to 12.3 ± 3.1 kg. Wrist range of motion in flexion, extension, ulnar deviation, and radial deviation improved significantly. Lichtman classification remained the same in 36 (90%) patients. Carpal height did not change. Intergroup evaluation showed no functional difference in response to surgery for different radiological Lichtman stages. More improvement was observed in patients with Lichtman stage II, but was not statistically significant. CONCLUSIONS Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sepehr Shiruei
- Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Abbas Moradi
- Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Fast-progressing Kienbock’s. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001114] [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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Hwang JS, Shim BJ, Li Q, Kim J, Baek GH. The Natural History of Kienböck’s Disease Diagnosed at More than Fifty Years of Age. Clin Orthop Surg 2022; 14:450-457. [PMID: 36061838 PMCID: PMC9393282 DOI: 10.4055/cios22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/23/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ji Sup Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bum Jin Shim
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Qingyuan Li
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Hand and Microsurgery, Tianjin Hospital, Tianjin, China
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Hegazy G, Seddik M, Massoud AH, Imam R, Alshal E, Zayed E, Darweash A. Capitate shortening osteotomy with or without vascularized bone grafting for the treatment of early stages of Kienböck's disease. INTERNATIONAL ORTHOPAEDICS 2021; 45:2635-2641. [PMID: 34264352 DOI: 10.1007/s00264-021-05103-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The study evaluates the procedures of capitate shortening osteotomy with or without vascularized bone grafting (VBG) for the treatment of stage II or IIIA Kienböck's disease with neutral ulnar variance. METHOD Forty-five patients with stage II (n = 21) and IIIA (n = 24) Kienböck's disease were included in the study. Patients were classified into two groups; isolated capitate shortening (ICS) group included 21 patients (stage II [n = 10] and stage IIIA [n = 11]) treated by capitate shortening without VBG of the lunate. Combined capitate shortening (CCS) group includes 24 patients (stage II [n = 11] and stage IIIA [n = 13]) who treated by capitate shortening combined with VBG of the lunate from the dorsal distal radius based on the fourth + fifth extensor compartment artery. All patients were evaluated pre- and post-operative for pain as measured by visual analogue scale score (VAS), range of motion (ROM), grip strength, modified Mayo wrist score (MMWS), lunate height index (LHI) ratio, and carpal height index (CHI) ratio. RESULTS The mean operative time for CCS procedure was 85 min (76 to 120) and for ICS was 58 min (47 to 65). The mean follow-up period for all patients was 33 months (29 to 47). Patients with stage IIIA Kienböck's disease treated by CCS procedure had better post-operative VAS, ROM, grip strength, MMWS, LHI, and CHI ratio than patients treated by ICS procedure. ICS procedure reported 28% failure rate versus 8% for CCS. No differences were found between CCS and ICS procedures in patients with stage II Kienböck's disease in the term of clinical, radiographic outcomes, or failure rate. CONCLUSION Using CCS procedure for the treatment of stage IIIA Kienböck's disease (lunate height collapse) with neutral ulnar variance can restore height and dimensions of the collapsed lunate and subsequently improve the final outcomes with lower failure rate. However, in patients with stage II Kienböck's disease (maintained lunate height), no advantages were noticed for CCS over ICS procedure. Lunate height index might be considered a prognostic factor for the treatment outcomes of Kienböck's disease.
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Affiliation(s)
- Galal Hegazy
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt.
| | - Mahmoud Seddik
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Abdel-Hakim Massoud
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Rashed Imam
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Ehab Alshal
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut CityAssiut, 71524, Egypt
| | - Emad Zayed
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Ahmed Darweash
- Orthopedic Department, Faculty of Medicine, Suez University, El Salam CitySuez, 43533, Egypt
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Kakinoki R, Nishichi H, Ikeguchi R, Ohta S, Otani K, Akagi M. Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:102-108. [PMID: 35415486 PMCID: PMC8991516 DOI: 10.1016/j.jhsg.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/30/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose This study aimed to report the outcomes of patients with stage III Kienböck disease after treatment with a vascularized bone graft (VBG) to the lunate combined with capitate shortening osteotomy (CS) after a more than 10-year follow-up. Methods A VBG to the lunate was combined with CS in 10 patients with stage III Kienböck disease (6 patients with stage IIIA and 4 with stage IIIB). We performed VBG, CS, and radial shortening osteotomy (RS) on 7 patients. Among them, 4 had undergone RS previously. The passive wrist extension angle and wrist flexion angle, grip strength (GS), carpal height ratio, Stahl index, visual analog scale of wrist pain, and Mayo modified wrist score were assessed before surgery and at the final follow-up. Results The flexion angle decreased markedly after surgery, when GS increased in all 10 patients. Radiographic examinations revealed that the carpal height ratio decreased in 9 of 10 patients, whereas the Stahl index increased in 8 patients and remained unchanged in 2. The oldest 3 of 7 patients who underwent VBG, CS, and RS exhibited fusion of the proximal carpals except the pisiform. The mean visual analog scale decreased from 27.6 before surgery to 5.7 afterward. The Mayo modified wrist score improved in 9 patients after surgery and remained unchanged in one. Conclusions In stage III Kienböck disease, VBG to the lunate combined with CS relieved wrist pain and increased GS and lunate height but was followed by severely restricted wrist motion. Fusion of the proximal carpals developed in 3 of 7 patients who received VBG with CS and RS. Type of study/level of evidence Therapeutic Ⅳ.
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Guzzini M, Princi G, Proietti L, Ferretti A. The use of Carbon-Peek volar plate after distal radius osteotomy for Kienbock's Disease in a volleyball athlete: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:152-155. [PMID: 31821300 PMCID: PMC7233714 DOI: 10.23750/abm.v90i12-s.8828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022]
Abstract
Kienbock’s Disease, or lunatomalacia, has uncertain etiopathogenesis, it is more common in male from 20 to 45-year-old. The Lichtman’s classification is the most used by authors and it divides Kienbock’s Disease in 4 stages according to radiographic parameters. In early stages could be performed a conservative treatment, but failure rate is high; various surgical techniques are available in case of failure or higher stages. We report a case of a 26-year-old female volleyball player affected by stage I Kienbock’s Disease who underwent distal radius osteotomy core decompression synthesized with Carbon-Peek plate fixation. Follow-up was performed with clinical evaluation (ROM analysis, VAS score, Quick Dash Score), wrist radiographs and wrist MRI. (www.actabiomedica.it)
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Affiliation(s)
- Matteo Guzzini
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.
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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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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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Matsumoto T, Kakinoki R, Ikeguchi R, Ohta S, Akagi M, Matsuda S. Vascularized Bone Graft to the Lunate Combined With Temporary Scaphocapitate Fixation for Treatment of Stage III Kienböck Disease: A Report of the Results, a Minimum of 2 Years After Surgery. J Hand Surg Am 2018; 43:773.e1-773.e7. [PMID: 29454599 DOI: 10.1016/j.jhsa.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 12/04/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To report the outcomes of patients with stage III Kienböck disease treated by vascularized bone graft (VBG) followed by temporary scaphocapitate (SC) fixation, a minimum of 2 years after surgery. METHODS Twenty-six patients (mean age, 35 years) with stage III Kienböck disease (16 with stage IIIA and 10 with stage IIIB), treated with VBG followed by SC fixation for 4 months, were retrospectively followed for at least 2 years (range, 24-121 months; mean, 61.8 months). The preoperative and postoperative assessments included range of motion (ROM) of the wrist, grip strength (GS), wrist pain, the modified Mayo wrist score (MMWS), carpal height ratio (CHR), Ståhl index (STI), and radioscaphoid angle (RSA). The outcomes of each assessment of the stages IIIA and IIIB groups at the final examination were compared with those before surgery. RESULTS In both stages IIIA and IIIB groups, GS increased after surgery. Decrease of CHR and STI was associated with the increase of RSA in the stage IIIA group after surgery, while RSA decreased, although neither CHR nor STI significantly increased in the stage IIIB patients. No patient demonstrated deterioration of the wrist pain after surgery. Twenty-one of 26 patients had an improved MMWS grade at the final follow-up. CONCLUSIONS Vascularized bone graft combined with SC fixation for 4 months provided greater GS, pain relief, and functional improvement compared with before surgery in both stages IIIA and IIIB groups. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Taiichi Matsumoto
- Department of Orthopedic Surgery, Kurashiki Central Hospital, Osaka, Japan
| | - Ryosuke Kakinoki
- Department of Orthopedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
| | - Ryosuke Ikeguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Ohta
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ikeguchi R, Kakinoki R, Aoyama T, Shibata KR, Otsuka S, Fukiage K, Nishijo K, Ishibe T, Shima Y, Otsuki B, Azuma T, Tsutsumi S, Nakayama T, Otsuka T, Nakamura T, Toguchida J. Regeneration of Osteonecrosis of Canine Scapho-lunate Using Bone Marrow Stromal Cells: Possible Therapeutic Approach for Kienböck Disease. Cell Transplant 2017; 15:411-22. [PMID: 16970283 DOI: 10.3727/000000006783981800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We evaluated the ability of canine bone marrow stromal cells (cBMSCs) to regenerate bone in a cavity of the scapholunate created by curretage and freeze–thawing with liquid nitrogen (LN). Autologous BMSCs were harvested from the iliac crest and expanded in vitro. Their potential to differentiate into osteo-, chondro-, and adipogenic lineages was confirmed using a standard differentiation induction assay. LN-treated scapholunates showed no regeneration of bone tissue when the cavity was left alone, demonstrating severe collapse and deformity as observed in human Kienböck disease. A combination of β-tri-calcium phosphate and a vascularized bone graft with autologous fibroblasts failed to regenerate bone in the LN-treated cavity. When the same procedure was performed using BMSCs, however, LN-treated scapholunates showed no collapse and deformity, and the cavity was completely filled with normal cancerous bone within 4 weeks. These results suggested the potential of using BMSCs to treat Kienböck disease.
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Affiliation(s)
- Ryosuke Ikeguchi
- Department of Tissue Regeneration, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
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13
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Early results of partial capitate shortening osteotomy in management of Kienböck disease. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Hayashig M, Makoto M, Kato H. Carpal tunnel syndrome associated with underlying Kienböck's disease. J Hand Surg Eur Vol 2015; 40:638-9. [PMID: 23461913 DOI: 10.1177/1753193413481937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Hayashig
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, and Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
| | - M Makoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, and Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
| | - H Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, and Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
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16
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Peters SJ, Degreef I, De Smet L. Avascular necrosis of the capitate: report of six cases and review of the literature. J Hand Surg Eur Vol 2015; 40:520-5. [PMID: 24570346 DOI: 10.1177/1753193414524876] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/12/2013] [Indexed: 02/03/2023]
Abstract
Avascular necrosis of the capitate is rare. Little is known about the aetiology, disease progression or optimal management. From 1992 to 2012 we treated six patients; four had a scaphocapitolunate arthrodesis and two had a four corner arthrodesis. The average follow up was 9 years (range 1-20). Three patients had good or excellent results, two fair and one poor, based on a visual analogue scale for pain and satisfaction and a Quick-DASH score. The Mayo wrist score was satisfactory in five cases and poor in one. Better results were seen when the arthrodesis fused. In the English, French and German literature 42 other cases were found. The aetiology, patient characteristics, clinical presentation, treatment and outcome were reviewed.
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Affiliation(s)
- S J Peters
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg, Belgium
| | - I Degreef
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg, Belgium
| | - L De Smet
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg, Belgium
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Rhee PC, Lin IC, Moran SL, Bishop AT, Shin AY. Scaphocapitate arthrodesis for Kienböck disease. J Hand Surg Am 2015; 40:745-51. [PMID: 25701486 DOI: 10.1016/j.jhsa.2014.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effect of scaphocapitate arthrodesis (SCA) on grip strength and wrist motion for patients with advanced stages of Kienböck disease. METHODS A retrospective review was conducted of patients with advanced stages of Kienböck disease (stages III-IV) who underwent SCA at our institution between 1991 and 2010 with a minimum of 1 year clinical follow-up. Outcome measures included preoperative and postoperative pain, range of motion, grip strength, complications, additional surgery, radiographic changes, and the modified Mayo Wrist and Lichtman Outcome scores. RESULTS Twenty-seven patients (17 males and 10 females) with a mean age of 41 years (range, 15-66 y) at the time of SCA were included in the study. The mean follow-up period was 60 months (range, 12 mo-16 y). Union was achieved in all 27 patients. Significant loss of mean motion was noted from preoperative to postoperative in wrist flexion (14°), extension (11°), and ulnar deviation (9°). However, significant improvement in grip strength was noted (+7 kg). Modified Mayo Wrist scores were mostly fair to poor and Lichtman scores were satisfactory in 32% (n = 7) of patients, yet 74% of patients returned to regular employment. Progressive radiographic carpal collapse and ulnar translocation of the carpus occurred, particularly in patients who had lunate excisions. However, no patients had symptoms attributable to carpal collapse or ulnar translocation that necessitated additional surgery. CONCLUSIONS SCA resulted in improved grip strength with correction of carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up. Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. Patients should be counseled that decrease in wrist range of motion will likely occur. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Peter C Rhee
- Division of Hand Surgery, Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Ines C Lin
- Division of Hand Surgery, Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Steven L Moran
- Division of Hand Surgery, Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Allen T Bishop
- Division of Hand Surgery, Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Alexander Y Shin
- Division of Hand Surgery, Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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18
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Igeta Y, Naito K, Sugiyama Y, Obata H, Aritomi K, Kaneko K, Obayashi O. Distal radius fracture after proximal row carpectomy. Int J Surg Case Rep 2015; 7C:165-7. [PMID: 25623755 PMCID: PMC4336416 DOI: 10.1016/j.ijscr.2015.01.026] [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] [Received: 10/14/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 12/03/2022] Open
Abstract
We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. The DRF is needed wrist range of motion. Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes with it.
Introduction We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Discussion Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. Conclusion The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC.
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Affiliation(s)
- Yuka Igeta
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Kiyohito Naito
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan; Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan.
| | - Yoichi Sugiyama
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Hiroyuki Obata
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Kentaro Aritomi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan
| | - Osamu Obayashi
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
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Tsujimoto R, Maeda J, Abe Y, Arima K, Tomita M, Koseki H, Kaida E, Aoyagi K, Osaki M. Epidemiology of Kienböck's disease in middle-aged and elderly Japanese women. Orthopedics 2015; 38:e14-8. [PMID: 25611414 DOI: 10.3928/01477447-20150105-54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/25/2014] [Indexed: 02/03/2023]
Abstract
Little research has been done on the prevalence of Kienböck's disease, and there is no consensus on the relationship between Kienböck's disease and negative ulnar variance. The goal of this cross-sectional study was to determine the prevalence of Kienböck's disease in middle-aged and elderly Japanese women and to clarify the relationship between Kienböck's disease and negative ulnar variance. The authors analyzed plain radiographs of both hands in women 40 years and older residing in the community to investigate the prevalence of Kienböck's disease and the relationship between Kienböck's disease and negative ulnar variance. Kienböck's disease was seen in 7 of the 572 participants. In the group with Kienböck's disease, ulnar variance did not differ significantly between affected (0.3 mm; SD, 1.5) and unaffected (0.3 mm; SD, 1.0; P=.285) sides. No significant difference was seen in ulnar variance values between the affected side in the group with Kienböck's disease and the normal group (P=.118). The number or proportion of participants with negative ulnar variance did not differ significantly between the affected side in the group with Kienböck's disease (3 of 7) and the unaffected side in the group with Kienböck's disease (1 of 7; P=.237) and between the affected side in the group with Kienböck's disease and the normal group (111 of 504; P=.189) by chi-square test. The prevalence of Kienböck's disease was 1.2% in middle-aged and elderly Japanese women. Negative ulnar variance is not a contributing factor to Kienböck's disease.
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Affiliation(s)
- David M. Lichtman
- Department of Orthopaedic Surgery, University of North Texas Health Science Center, John Peter Smith Hospital, Fort Worth, Texas
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21
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Ueba Y, Kakinoki R, Nakajima Y, Kotoura Y. Morphology and histology of the collapsed lunate in advanced kienböck disease. ACTA ACUST UNITED AC 2013; 18:141-9. [PMID: 24164116 DOI: 10.1142/s0218810413500160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Morphological and histological changes of 24 collapsed lunates in advanced Kienböck disease were investigated. Articular cartilage of a collapsed lunate were consistently attenuated or disappeared. The proximal articular cartilage facing the radius is generally more affected than the distal articular cartilage facing the capitate. There was one major fracture in addition to multiple minor fractures in the collapsed lunate. Fracture patterns were classified into three types according to the directions of major fracture, namely horizontal type, dual oblique type, and vertical type. There were viable and necrotic areas in the collapsed lunate. Active new bone formation was observed at the junction between the viable and necrotic bone area of the collapsed lunate in advanced Kienböck disease.
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Affiliation(s)
- Yasuo Ueba
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
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22
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Hayter CL, Gold SL, Potter HG. Magnetic resonance imaging of the wrist: Bone and cartilage injury. J Magn Reson Imaging 2013; 37:1005-19. [DOI: 10.1002/jmri.23845] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 08/29/2012] [Indexed: 01/13/2023] Open
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Primary results of Kienböck's disease treated using balloon kyphoplasty system. Arch Orthop Trauma Surg 2012; 132:677-83. [PMID: 22065146 DOI: 10.1007/s00402-011-1428-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Kienböck's disease is difficult to treat and optimal treatments for stages II to III continue to elude investigators. We hypothesized that impacting the ischemic cancellous trabeculae and increasing the strength and rigidity of the lunate with balloon kyphoplasty can prevent lunate collapse, relieve the symptoms, and increase wrist range of motion. The purpose of this study was to demonstrate the feasibility of percutaneous balloon kyphoplasty for treatment of stage II to III Kienböck's disease. METHODS The study group comprised five patients (two in stage II, three in stage III). All were treated with balloon kyphoplasty. Pain, strength, and wrist flexion/extension range of motion were evaluated preoperatively and postoperatively. The Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score were used to evaluate outcomes. Patient satisfaction was also assessed. Comparisons between preoperative and postoperative data were made with SPSS software. RESULTS Clinical data were collected at a mean of 26.6 months (range 24-28 months) postoperatively. Pain was significantly reduced from 6.8 ± 0.8 in the visual analog scale preoperatively to 0.6 ± 0.9 at the 24-month follow-up. Strength and range of motion were improved postoperatively in all patients. The mean DASH score was 11.3 (range 6.7-18.3), and the mean Mayo Wrist Score was 78 (range 75-80). All five patients returned to their previous occupations. CONCLUSIONS Balloon kyphoplasty can prevent lunate collapse, reduce pain, and improve wrist function of patients with stage II to III Kienböck's disease. Further studies regarding the feasibility of this new approach are warranted.
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Ogawa T, Ishii T, Mishima H, Nishino T, Watanabe A, Ochiai N. Is low-intensity pulsed ultrasound effective for revitalizing a severely necrotic small bone? An experimental rabbit model. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:2028-2036. [PMID: 21963034 DOI: 10.1016/j.ultrasmedbio.2011.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 07/04/2011] [Accepted: 08/13/2011] [Indexed: 05/31/2023]
Abstract
Previously, we successfully applied a new method composed of drilling, bone marrow transplantation (BMT), external fixation and low-intensity pulsed ultrasound (LIPUS) for the clinical treatment of Kienböck's disease. The purpose of this study was to investigate whether bone regeneration can be induced by LIPUS and/or multiple drilling and/or BMT within a severely necrotic small-bone rabbit model. Eighteen rabbits were divided into three groups (BMT, drilling and control) and LIPUS stimulation was introduced daily for 8 weeks post-transplantation. Next, 12 additional rabbits were produced for the BMT group and LIPUS stimulation was introduced daily for 4 and 12 weeks (n = 6 for each). Histopathologically, new bone formations were rarely observed in the drilling and control groups. In the BMT group, the mineralizing surface areas of LIPUS(+) showed a significant increase compared with LIPUS(-) for 8 weeks. LIPUS treatment alone did not accelerate the revitalization of necrotic bones. However, LIPUS combined with BMT tended to promote new bone formation.
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Affiliation(s)
- Takeshi Ogawa
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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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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Porteous R, Harish S, Parasu N. Imaging of ulnar-sided wrist pain. Can Assoc Radiol J 2010; 63:18-29. [PMID: 20864307 DOI: 10.1016/j.carj.2010.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 11/28/2022] Open
Abstract
Pain on the ulnar side of the wrist is a complex diagnostic dilemma. This is mainly due to the small size and complexity of the anatomical structures. The issue is compounded by the occurrence of positive imaging findings that are clinically asymptomatic. This pictorial essay deals with the imaging manifestations of different causes of ulnar-sided wrist pain.
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Affiliation(s)
- Rory Porteous
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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28
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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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Kanatani T, Yamasaki K, Fujioka H. Carpal tunnel syndrome associated with a fracture of a silicone implant for Kienböck's disease: two case reports. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2010; 15:225-227. [PMID: 21089199 DOI: 10.1142/s0218810410004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 07/08/2010] [Accepted: 07/13/2010] [Indexed: 05/30/2023]
Abstract
In this report, two cases presenting with CTS including a fracture of the silicone implant for Kienböck's disease after replacement over 20 years postoperatively where CTR ceased the symptoms of CTS. The major symptom characteristic was the median nerve impairment with less emphasis on the limited range of motion of the wrist or wrist pain due to a fracture of the silicone implant. There was an unlikely association between the fracture of the implant and CTS, which was confirmed by the operative findings of tenosynovitis and thickness of the degenerated transverse ligament without a significant protrusion of the silicone implant.
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Affiliation(s)
- Takako Kanatani
- Department of Orthopaedics, Kobe Rosai Hospital, Kobe, Japan.
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30
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Cheon SJ, Lim JM, Kim HT, Suh JT. Treatment of Kienböck's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience. ACTA ACUST UNITED AC 2010. [DOI: 10.4055/jkoa.2010.45.4.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sang Jin Cheon
- Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea
| | - Jong Min Lim
- Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea
| | - Hui Taek Kim
- Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea
| | - Jeung Tak Suh
- Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea
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Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol 2010; 39:837-57. [PMID: 20012039 PMCID: PMC2904904 DOI: 10.1007/s00256-009-0842-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 11/14/2009] [Accepted: 11/17/2009] [Indexed: 02/02/2023]
Abstract
Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed.
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Affiliation(s)
- Atsuya Watanabe
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Felipe Souza
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter S. Vezeridis
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| | - Hiroshi Yoshioka
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA ,Department of Radiological Sciences, University of California-Irvine, Irvine, CA USA ,Department of Radiological Sciences, UC Irvine Medical Center, 101 City Drive South, Route 140, Orange, CA 92868 USA
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Gittard SD, Narayan RJ, Lusk J, Morel P, Stockmans F, Ramsey M, Laverde C, Phillips J, Monteiro-Riviere NA, Ovsianikov A, Chichkov BN. Rapid prototyping of scaphoid and lunate bones. Biotechnol J 2009; 4:129-34. [PMID: 19156737 DOI: 10.1002/biot.200800233] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, a novel rapid prototyping technology was used to fabricate scaphoid and lunate bone prostheses, two carpal bones that are prone to avascular necrosis. Carpal prostheses were fabricated with an Envisiontec Perfactory SXGA stereolithography system using Envisiontec eShell 200 photocurable polymer. Fabrication was guided using 3-D models, which were generated using Mimics software (Materialise NV, Leuven, Belgium) from patient computer tomography data. The prostheses were fabricated in a layer-by-layer manner; approximately 50-microm thick layers were observed in the prostheses. Hardness and Young's modulus values of polymerized eShell 200 material were 93.8 +/- 7.25 MPa and 3050 +/- 90 MPa, respectively. The minimum compressive force required for fracture was 1360 N for the scaphoid prosthesis and 1248 N for the lunate prosthesis. Polymerized Envisiontec eShell material exhibited high human neonatal epidermal keratinocyte cell viability rate in an MTT assay. The results of this study indicate that small bone prostheses fabricated by stereolithography using eShell 200 polymer may have suitable geometry, mechanical properties, and cytocompatibility properties for in vivo use.
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Affiliation(s)
- Shaun D Gittard
- Joint Department of Biomedical Engineering, University of North Carolina/North Carolina State University, Raleigh, NC 27599-7575, USA
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Isolated Capitate Shortening Osteotomy for the Early Stage of Kienböck Disease with Neutral Ulnar Variance. Plast Reconstr Surg 2009; 124:560-566. [DOI: 10.1097/prs.0b013e3181addc50] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kakinoki R, Yamakawa T, Nakayama K, Morimoto Y, Nakamura T. Treatment of progressive necrosis of the lunate bone (Kienböck disease) after unsuccessful radial osteotomy. ACTA ACUST UNITED AC 2009; 41:267-71. [PMID: 17886131 DOI: 10.1080/02844310600759657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the treatment of three patients with stage 3 Kienböck disease that had advanced after radial shortening (n = 2) or lateral wedge osteotomy (n = 1). We shortened the capitate and fused the capitate and hamate, and applied a vascularised bone graft taken from the distal dorsal radius to the lunate. This was successful in all three patients.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Abstract
Treatments of Kienböck's disease range from conservative measures-usually immobilization during the acute phase-to such procedures as joint leveling by radial shortening or ulnar lengthening, intercarpal fusion, silastic arthroplasty, and vascularized bone grafts. Joint-leveling procedures have many complications such as nonunion, hardware problems, and pain. In this study, 34 patients with Kienböck's disease, stage 1 through 3B in Lichtman's classification, were treated with a new technique: a double V-shaped metaphyseal osteotomy of the distal radius and dorsal tilt of the distal radius. The patients were evaluated clinically regarding pain, which decreased in 88% of patients; range of motion, which improved in all patients; and grip strength, which improved by 90%. Progression of the disease was assessed radiologically by determining the carpal height ratio and the carpal ulnar distance ratio. There were no cases with nonunion of the radial osteotomy at follow-up. This procedure is an effective treatment method for Kienböck's disease in wrists that do not have degenerative changes in the adjacent carpal joints.
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Affiliation(s)
- Tarek Ahmed Aly
- Orthopedic Department, Tanta University School of Medicine, Gharbia, Egypt
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The treatment of Kienböck disease with vascularized bone graft from dorsal radius. Arch Orthop Trauma Surg 2009; 129:171-5. [PMID: 18270720 DOI: 10.1007/s00402-008-0586-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Numerous surgical treatment options are proposed for the Kienböck disease but there has not been a consensus on the most appropriate method yet. The aim of this study is to present our experience and preliminary results of the use of vascularized bone graft from dorsal radius. MATERIALS AND METHODS Second and third intercompartmental supraretinacular artery pedicled bone graft has been used to treat 11 patients with Kienböck disease between 2001 and 2006. The average follow-up period was 37 months (range 19-77 months). Pre- and post-operative range of motion, pain and grip strength, radiologic parameters such as carpal height ratio, Stahl index and scapholunate angle were evaluated. RESULTS Eleven patients were composed of two stage II, one stage IIIA and eight stage IIIB patients according to Lichtmann classification. At the end of the observation period, five excellent, four good, one fair and one poor results were observed. There were no or little changes in carpal height ratio and Stahl index. Pain has diminished considerably. DISCUSSION We believe that the treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and need no other additional procedures.
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Meena DS, Saini N, Kundanani V, Chaudhary L, Meena D. Distraction histiogenesis for treatment of Kienbock's disease: A 2- to 8-year follow-up. Indian J Orthop 2009; 43:189-93. [PMID: 19838369 PMCID: PMC2762252 DOI: 10.4103/0019-5413.50854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distraction histiogenesis is known to enhance vascularity and stimulate new tissue formation. Its use in Kienbock's disease is not reported in the literature, so we proposed to study the outcome after distraction histiogenesis in treating this condition. MATERIALS AND METHODS This prospective study comprised of six patients (two male and four female) with mean age 18.16 years (range 21-35 years) with clinicoradiologically diagnosed Lichtman stage II (n = 3) and stage III (n = 3) Kienbock's disease with a mean duration of symptoms 6.67 months. The ulnar variance was neutral in two and was negative in four patients treated with the application of Joshi external stabilization system (JESS) across the wrist. The gradual distraction was done at a rate of 0.5 mm/day. After the distraction of 5-7 mm, the distractors were kept static for 3 weeks. The wrist was mobilized by using hinged distractors for next 3 weeks. Later short cockup splint was used for further 4 weeks. At the end of minimum 2 years, an assessment was done on the basis of relief of symptoms, ability to perform activities of daily living, range of movement at wrist, grip strength, and on radiology (change in the density of bone and C:MC ratio i.e ratio of carpal height to third metacarpal height). RESULTS The mean follow-up was of 4.5 years (range 2-8 years). The average duration of treatment was 5.3 months (range 4.5-6 months), and the duration of distraction (both static and hinged) was 8 weeks. Clinically all the patients were relieved of the symptoms with an increase in the range of wrist movement (ulnar deviation increased from 20.8 degrees to 29.5 degrees , radial deviation from 17.5 degrees to 21 degrees , dorsiflexion from 37.5 degrees to 52.5 degrees , and palmer flexion from 38.3 degrees to 47.5 degrees ). At the last follow-up, activities of daily living were not affected, and all the patients were on their previous jobs without any fresh complaints. The average grip strength increased to 73-86% of normal. Radiologically the C:MC ratio (ratio of carpal height to third metacarpal height) did not show any significant improvement, but the density of lunate decreased. CONCLUSION Distraction histiogenesis when used in Lichtman stage II and III with negative or neutral ulnar variance gives good symptomatic relief, allowing return to normal activities. This study has also shown that reparative process is possible in avascular bone by distraction. The authors recommend further research in this modality of treatment.
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Affiliation(s)
- DS Meena
- Department of Orthopaedics, SMS Medical College and attached group of Hospitals, Jaipur, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College and attached group of Hospitals, Jaipur, India,Address for correspondence: Dr. Narender Saini, Plot No B-10, Brij Vihar Vistar, Near Jagatpura Flyover, Jagatpura, Jaipur, Rajasthan-302 025, India. E-mail:
| | - Vishal Kundanani
- Department of Orthopaedics, SMS Medical College and attached group of Hospitals, Jaipur, India
| | - Lokesh Chaudhary
- Department of Orthopaedics, SMS Medical College and attached group of Hospitals, Jaipur, India
| | - Dinesh Meena
- Department of Orthopaedics, SMS Medical College and attached group of Hospitals, Jaipur, India
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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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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the anatomy and the biomechanical properties of the wrist. 2. Understand the standard examination process for wrist injuries. 3. Accurately diagnose common wrist conditions. 4. Establish a management plan for wrist problems. BACKGROUND Although common, wrist injuries and conditions are difficult to treat if the physician is unfamiliar with their management. METHODS Wrist anatomy and kinematics are discussed. Physical and radiographic examinations that are mandatory for diagnosing wrist conditions are presented. Common wrist injuries are reviewed. RESULTS Understanding the anatomy and kinematics of the wrist is important in diagnosing and treating wrist conditions and in predicting outcomes after treatment. Physical examination of the wrist requires an understanding of the surface anatomy and a number of specific maneuvers. Physicians should also be familiar with other diagnostic tests, which include radiography, arthrography, computed tomography, magnetic resonance imaging, and arthroscopy. CONCLUSIONS Physicians who treat wrist injuries should be able to establish an adequate management plan for common wrist injuries and conditions and be able to predict outcomes based on these treatment plans.
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Affiliation(s)
- Kenji Kawamura
- Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System
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Lecomte F, Wavreille G, Limousin M, Strouk G, Fontaine C, Chantelot C. Résection de la rangée proximale des os du carpe. ACTA ACUST UNITED AC 2007; 93:444-54. [PMID: 17878835 DOI: 10.1016/s0035-1040(07)90326-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF THE STUDY Resection of the proximal row of the carpus which simplifies the radiocarpal joint is mainly performed for advanced collapse. With the development of several therapeutic alternatives, further study of outcome is warranted to better identify indications. MATERIAL AND METHODS Twenty-five patients who underwent proximal row carpectomy between January 1999 and February 2004 were reviewed clinically and radiologically at 30 months mean follow-up. Three main etiologies were noted: scaphoid fracture (n=9), scapholunate dissociation (n=9), Kienböck disease (n=6). A posterior approach was used for all patients. Outcome was assessed clinically (pain, force, mobility), radiologically (carpal height, radiocapital space), and subjectively by the patient. Resumption of occupational activity was noted as were the Cooney and Culp scores. RESULTS Average flexion-extension was 60 degrees . Average wrist force was 65% of the healthy side. Pain improved in 88% of wrists and the mean subjective score was 15.2. The mean Cooney and Culp scores were 58 and 67.8 respectively. A reduction in the height of the new articular space was not correlated with less favorable clinical outcome. Outcome in patients with Kienböck disease were less favorable than in trauma patients but the difference did not reach significance. DISCUSSION First row carpectomy is a paliative procedure which should only be performed when conservative treatment is no longer a valid option. Indications should be limited to Watson grade II, before cartilaginous damage affects the head of the capitatum. New techniques such as fusion-shortening, theoretically similar to resection, can now be used for advances collapse. We prefer resection over four-bone arthrodesis because of the lower risk of complications. In Kienböck disease, first row carpectomy should only be used for selected patients (Lichtmann III) due to the risk of early degeneration of the capitatum and radius heads.
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Affiliation(s)
- F Lecomte
- Service d'Orthopédie B, Chirurgie de la main et du membre supérieur, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille.
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Altay T, Kaya A, Karapinar L, Ozturk H, Kayali C. Is radial shortening useful for Litchman stage 3B Kienbock's disease? INTERNATIONAL ORTHOPAEDICS 2007; 32:747-52. [PMID: 17724595 PMCID: PMC2898952 DOI: 10.1007/s00264-007-0428-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/12/2007] [Accepted: 06/14/2007] [Indexed: 10/22/2022]
Abstract
Treatment of Litchman stage 3 Kienböck's disease is still controversial. In this study our aim was to evaluate the effectiveness of radial shortening on stage 3B Kienböck's disease in comparison with stage 3A cases. Radial shortening was performed for 23 patients who had stage 3A (group I, n = 13) and 3B (group II, n = 10) Kienböck's disease between 1994 and 2004. The radial osteotomy was performed 4.5 cm proximal to the distal articular surface. The mean shortening was 2.6 mm (range 2 to 4.5). The average follow-up period was 85 months (range 26-147). Based on the modified Nakamura system, the mean clinical points were 14.3 in group I and 13.3 in group II. There was no statistical difference between both groups with regard to clinical points (P = 0.483). The extension-flexion arc showed significant improvement in both groups. Based on the results of this long-term follow-up study, we concluded that radial shortening osteotomy can be performed in the treatment of type 3B Kienböck's disease as reliably as type 3A, despite the lack of evident radiological improvement.
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Affiliation(s)
- Taskin Altay
- Department of Orthopaedics, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
- Department of Traumatology, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
| | - Ahmet Kaya
- Department of Orthopaedics, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
- Department of Traumatology, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
| | - Levent Karapinar
- Department of Orthopaedics, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
- Department of Traumatology, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
| | - Hasan Ozturk
- Department of Orthopaedics, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
- Department of Traumatology, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
| | - Cemil Kayali
- Department of Orthopaedics, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
- Department of Traumatology, Izmir-Tepecik Education and Research Hospital, 35100 Izmir, Turkey
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Hermans S, Degreef I, De Smet L. Vascularised bone graft for Kienböck disease: preliminary results. ACTA ACUST UNITED AC 2007; 41:77-81. [PMID: 17605440 DOI: 10.1080/02844310601127441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We treated eight patients with lunatomalacia by harvesting a pedicled, vascularised bone segment from the dorsal aspect of the distal radius and grafting it into the lunate. Its effect on carpal collapse and clinical outcome was assessed at a mean follow-up of 29 months (range 13-42). Postoperatively patients had considerably less pain (45% during activity and 74% at rest). Postoperative mean range of movement was 65% (range 43%-76%) (SD: 13) of the unaffected side. Three patients had an excellent result, three had good results, one had a fair result, and one patient was unsatisfied. The mean postoperative disabilities of the arm, shoulder, and hand score was 29.8 (compared with 40.0 preoperatively).
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Affiliation(s)
- Stijn Hermans
- Department of Orthopedic Surgery, U.Z. Pellenberg, Lubbeek, Pellenberg, Belgium
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Abstract
Vascularized bone graft procedures have been applied to several maladies of the carpus including proximal pole fractures of the scaphoid, Preiser's disease, and Kienböck's disease. Vascularized bone grafts are capable of primary bony healing without creeping substitution and can thus accelerate fracture healing, replace deficient bone, and revascularize ischemic bone. Long-term data are now available to evaluate the benefits and deficiencies of vascularized grafts in the treatment of many carpal maladies. This article reviews the pertinent literature and provides some treatment algorithms for the use of vascularized bone grafting in cases of carpal pathology.
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Affiliation(s)
- Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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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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Gong HS, Chung MS, Lee YH, Lee S, Lee JO, Baek GH. Arthroplasty for advanced Kienböck's disease using a radial bone flap with a vascularised wrapping of pronator quadratus. ACTA ACUST UNITED AC 2006; 88:623-8. [PMID: 16645108 DOI: 10.1302/0301-620x.88b5.16888] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have performed a form of lunate replacement arthroplasty, which included excision of the lunate and insertion of a vascularised radial bone flap wrapped in pronator quadratus, for stage IIIB or stage IV Kienböck's disease, in 41 patients who have been followed up for more than three years. All patients reported an improvement in their symptoms, and 20 of the 41 became free of pain after the operation. Extension and flexion of the wrist were increased by a mean of 9 degrees and 6 degrees , respectively (p < 0.05). The radioscaphoid angle and the carpal height ratio were not significantly changed and only minimal deterioration was observed due to degenerative change. The size, density or location of the inserted bone did not change with time. A vascularised radial bone flap wrapped in pronator quadratus can be a reliable treatment option for advanced Kienböck's disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
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Affiliation(s)
- H S Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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Affiliation(s)
- Rebecca A Loredo
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78284, USA.
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Sakai A, Toba N, Oshige T, Menuki K, Hirasawa H, Nakamura T. Kienböck disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core. ACTA ACUST UNITED AC 2005; 9:145-9. [PMID: 15810098 DOI: 10.1142/s0218810404002315] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Accepted: 04/27/2004] [Indexed: 11/18/2022]
Abstract
We hypothesised that using a palmaris longus tendon ball (PLTB) with bone core (w bc) after excisional arthroplasty for Kienböck disease would maintain post-operative carpal height compared to a PLTB without bone core (w/o bc). Seventeen hands of 16 consecutive patients with Kienböck disease at Lichtman stage IIIA or IIIB were treated by replacement of the lunate with a PLTB w bc or w/o bc. We evaluated the clinical and radiological outcomes at one, three and 12 months after surgery. According to Dornan and Lichtman criteria respectively, there were no significant differences between the two groups. In the w bc group, the post-operative values of the carpal height ratio (CHR) were maintained at the same level as pre-operative values for one year, while the post-operative CHR values in the w/o bc group were significantly lower than those in the w bc group. Our results indicate that in Kienböck disease, arthroplasty using a PLTB w bc can maintain CHR at one year after surgery compared to arthroplasty using a PLTB w/o bc.
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Affiliation(s)
- A Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
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Moran SL, Cooney WP, Berger RA, Bishop AT, Shin AY. The use of the 4 + 5 extensor compartmental vascularized bone graft for the treatment of Kienböck's disease. J Hand Surg Am 2005; 30:50-8. [PMID: 15680555 DOI: 10.1016/j.jhsa.2004.10.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 10/11/2004] [Indexed: 02/07/2023]
Abstract
PURPOSE The use of vascularized bone grafts for the treatment of Kienböck's disease may prevent ongoing lunate collapse and provide relief of wrist symptomatology. This study examines our experience with the use of the 4 + 5 extensor compartmental artery (ECA) bone graft for the treatment of Kienböck's disease. METHODS A retrospective review was performed of all patients having pedicled vascularized bone grafts for Kienböck's disease between 1991 and 2002. Only those patients who had reconstruction with a 4 + 5 ECA graft were included in the study. Presurgical and postsurgical measurements included range of motion, grip strength, and pain evaluation. Measurements of the radiolunate angle, radioscaphoid angle, Stahl's index, and carpal height ratio were taken from presurgical and final follow-up radiographs. Postsurgical magnetic resonance imaging scans were also examined to verify revascularization of the lunate. Statistical analysis was performed using Student's t test. A chi-square test was used to evaluate the effects of lunate revascularization on radiographic progression of disease. Twenty-six 4 + 5 ECA vascularized bone grafts were performed as treatment for Kienböck's disease. The average patient age was 32 years. At the time of surgery 12 patients were graded as stage II, 10 as IIIA, and 4 as IIIB. Mean follow-up time was 31 months. RESULTS At a mean follow-up of 3 months, motion improved from 68% to 71% of the unaffected side, grip strength improved from 50% to 89% of the unaffected side, and 92% of patients had significant improvement in their pain. Satisfactory results were seen in 85% of patients based on the Lichtman outcome score. Seventy-seven percent of patients showed no further collapse on postsurgical radiographs. Sixty-five percent of patients had follow-up magnetic resonance imaging scans at a mean of 20 months after surgery. Seventy-one percent of patients showed evidence of revascularization with improvement in the T2 and/or T1 signal. CONCLUSIONS The 4 + 5 ECA bone graft provides a reliable alternative for the treatment of Kienböck's disease and may aid in lunate revascularization.
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Affiliation(s)
- Steven L Moran
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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