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Wernér K, Anttila T, Hulkkonen S, Viljakka T, Haapamäki V, Ryhänen J. Detecting Avascular Necrosis of the Lunate from Radiographs Using a Deep-Learning Model. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:706-714. [PMID: 38343256 PMCID: PMC11031541 DOI: 10.1007/s10278-023-00964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 04/20/2024]
Abstract
Deep-learning (DL) algorithms have the potential to change medical image classification and diagnostics in the coming decade. Delayed diagnosis and treatment of avascular necrosis (AVN) of the lunate may have a detrimental effect on patient hand function. The aim of this study was to use a segmentation-based DL model to diagnose AVN of the lunate from wrist postero-anterior radiographs. A total of 319 radiographs of the diseased lunate and 1228 control radiographs were gathered from Helsinki University Central Hospital database. Of these, 10% were separated to form a test set for model validation. MRI confirmed the absence of disease. In cases of AVN of the lunate, a hand surgeon at Helsinki University Hospital validated the accurate diagnosis using either MRI or radiography. For detection of AVN, the model had a sensitivity of 93.33% (95% confidence interval (CI) 77.93-99.18%), specificity of 93.28% (95% CI 87.18-97.05%), and accuracy of 93.28% (95% CI 87.99-96.73%). The area under the receiver operating characteristic curve was 0.94 (95% CI 0.88-0.99). Compared to three clinical experts, the DL model had better AUC than one clinical expert and only one expert had higher accuracy than the DL model. The results were otherwise similar between the model and clinical experts. Our DL model performed well and may be a future beneficial tool for screening of AVN of the lunate.
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Affiliation(s)
- Krista Wernér
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Turkka Anttila
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Sina Hulkkonen
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
| | | | - Ville Haapamäki
- Department of Radiology, HUS Diagnostic Center, HUS Medical Imaging Center, Helsinki, Finland
| | - Jorma Ryhänen
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
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Wassef C, Rechter GR, Tatapudi S, Sambhariya V, Pientka WF. The Effect of Radial Inclination on the Stage of Kienbock Disease at the Time of Initial Diagnosis. Hand (N Y) 2024:15589447231221246. [PMID: 38164909 DOI: 10.1177/15589447231221246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Negative ulnar variance is a widely accepted risk factor for the development of Kienbock disease (KD). Variation in radial inclination has been proposed as a risk factor, but evidence thus far has been inconclusive. We aim to clarify the relationship between radial inclination and KD. METHODS A retrospective analysis of all KD patients from a single institution from 2007 to 2021 was conducted. Radiographs were reviewed to measure anatomic parameters and stage of disease. An exploratory multinomial regression model was created to examine the association of patient age, radial height, ulnar variance, radial inclination, volar tilt, scapholunate angle, duration of symptoms prior to evaluation, history of wrist trauma, and diagnosis of diabetes with stage of disease. RESULTS Fifty-seven cases of KD were identified, with a mean duration of disease of 33.3 months. A history of trauma to the wrist was common (53%) and significantly associated with stage of disease at initial presentation. Twenty-seven cases (47%) were stage IIIB or greater. The average initial radial inclination, radial height, and ulnar variance was 21.9°, 10.7 mm, and -1.23 mm, respectively. A multinominal logistic regression model revealed decreased initial radial inclination is associated with Lichtman stage IIIB or greater at the time of initial patient presentation. CONCLUSIONS A correlation exists between decreased radial inclination and more advanced KD at presentation, suggesting this may be a risk factor for disease progression. This correlation is strengthened by our finding of decreased ulnar variance being associated with later stage at presentation, which is one of the most widely accepted proposed risk factors for development and progression of disease. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Suhas Tatapudi
- University of North Texas Health Science Center, Fort Worth, USA
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Park JY, Kim JK, Shin YH. Comparison of Long-term Outcomes between Nonoperative Treatment and Vascularized Bone Graft for Kienböck Disease: A Systematic Review and Single-Arm Meta-Analysis. Clin Orthop Surg 2023; 15:643-652. [PMID: 37529196 PMCID: PMC10375810 DOI: 10.4055/cios22307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/07/2022] [Accepted: 01/12/2023] [Indexed: 08/03/2023] Open
Abstract
Background This systematic literature review compared long-term outcomes between nonoperative treatment and vascularized bone graft (VBG) in patients with Kienböck disease. Methods We systematically reviewed studies on nonoperative treatment and VBG for Kienböck disease with a mean follow-up of ≥ 5 years. A systematic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase databases to select relevant articles. Data on patient demographics, treatment details, and outcomes were extracted. Results Twelve studies (6 for nonoperative treatment and 6 for VBG) were included. The proportion of wrists showing worsening Lichtman stages after treatment was 40.2% (95% confidence interval [CI], 25.7-56.6) and 17.0% (95% CI, 10.2%-26.9%) in the nonoperative treatment group and VBG group, respectively. No change in the stage was observed in 52.4% (95% CI, 25.5%-78.0%) and 77.8% (95% CI, 66.7%-86.0%) of the wrists in the nonoperative treatment group and VBG group, respectively. The proportion of wrists without pain at the final follow-up was 29.2% (95% CI, 16.6%-46.1%) and 35.9% (95% CI, 22.6%-52.0%) in the nonoperative treatment group and VBG group, respectively. The proportion of wrists with more than a moderate degree was 30.4% (95% CI, 22.7%-39.4%) and 12.9% (95% CI, 5.5%-27.4%) in the nonoperative treatment group and VBG group, respectively. The 95% CIs of the mean wrist range of motion and mean grip strength ratio of the affected side to the contralateral side substantially overlapped in the two groups. Conclusions The VBG group showed greater improvement in the radiographic stage and wrist pain than did the nonoperative treatment group after treatment, but meaningful differences in parameters were not observed. Further well-designed studies are needed to confirm the superiority of VBG to nonoperative treatment regarding radiographic and clinical outcomes.
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Affiliation(s)
- Jin Yeop Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bouri F, Hantouly AT, Alzobi O, Toubasi AA, Kayali H, Fuad M, Muneer M, Hagert E, Ibrahim A. Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:435-444. [PMID: 37521555 PMCID: PMC10382890 DOI: 10.1016/j.jhsg.2023.03.014] [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: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.
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Affiliation(s)
- Fadi Bouri
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mazhar Fuad
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Muneer
- Department of Plastic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden
| | - Ayman Ibrahim
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Shams A, Samy MA, Mesregah MK, Abosalem AA. Scapho-luno-capitate fusion with proximal lunate articular surface preservation for management of grade IIIA Kienböck's disease: a prospective case series. J Orthop Traumatol 2023; 24:23. [PMID: 37199858 DOI: 10.1186/s10195-023-00703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Kienböck's disease is idiopathic lunate avascular necrosis, which may lead to lunate collapse, abnormal carpal motion and wrist arthritis. The current study aimed to assess the outcomes of treating stage IIIA Kienböck's disease by a novel technique of limited carpal fusion via partial lunate excision with preservation of the proximal lunate surface and scapho-luno-capitate (SLC) fusion. MATERIALS AND METHODS We conducted a prospective study of patients with grade IIIA Kienböck's disease managed with a novel technique of limited carpal fusion comprising SLC fusion with preservation of the proximal lunate articular cartilage. Autologous iliac crest bone grafting and K-wires fixation were used to enhance the osteosynthesis of the SLC fusion. The minimum follow-up period was 1 year. A visual analog scale (VAS) and the Mayo Wrist Score were utilized for the evaluation of patient residual pain and functional assessment, respectively. A digital Smedley dynamometer was used to measure the grip strength. The modified carpal height ratio (MCHR) was used for monitoring carpal collapse. The radioscaphoid angle, scapholunate angle, and the modified carpal-ulnar distance ratio were used for the assessment of carpal bones alignment and ulnar translocation of carpal bones. RESULTS This study included 20 patients with a mean age of 27.9 ± 5.5 years. At the last follow-up, the mean range of flexion/extension range of motion (% of normal side) improved from 52.8 ± 5.4% to 65.7 ± 11.1%, P = 0.002, the mean grip strength (% of normal side) improved from 54.6 ± 11.8% to 88.3 ± 12.4%, P = 0.001, the mean Mayo Wrist Score improved from 41.5 ± 8.2 to 81 ± 9.2, P = 0.002, and the mean VAS score reduced from 6.1 ± 1.6 to 0.6 ± 0.4, P = 0.004. The mean follow-up MCHR improved from 1.46 ± 0.11 to 1.59 ± 0.34, P = 0.112. The mean radioscaphoid angle improved from 63 ± 10º to 49 ± 6º, P = 0.011. The mean scapholunate angle increased from 32 ± 6º to 47 ± 8º, P = 0.004. The mean modified carpal-ulnar distance ratio was preserved and none of the patients developed ulnar translocation of the carpal bones. Radiological union was achieved in all patients. CONCLUSIONS Scapho-luno-capitate fusion with partial lunate excision and preservation of the proximal lunate surface is a valuable option for treating stage IIIA Kienböck's disease, with satisfactory outcomes. Level of evidence Level IV. Trial registration Not applicable.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Ahmed Samy
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| | - Ahmed Abdelazim Abosalem
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
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MacLean SBM, Bain GI. Lunate Fracture Morphology in Kienbock's Disease-A Computed Tomography Study. J Wrist Surg 2023; 12:128-134. [PMID: 36926207 PMCID: PMC10010897 DOI: 10.1055/s-0042-1756497] [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: 04/18/2022] [Accepted: 06/28/2022] [Indexed: 10/10/2022]
Abstract
Background The pathogenesis of Kienbock's disease is poorly understood. The coronal fracture line is acknowledged as a poor prognostic marker in the disease. Other fracture types in the Kienbock's wrist have subsequently been identified. Questions/Purposes The aim is to study the fracture morphology of the lunate in a cohort of patients using computed tomography. Methods Patient images were acquired using a set protocol with four-dimensional computed tomography scanning. Images were reviewed by two orthopaedic surgeons and a consultant radiologist. Static and dynamic images were assessed and a fracture map created. The relationship of fracture type to other parameters was then analyzed. Results Twenty-three patients were included in the study, including 11 males and 12 females, with a mean age of 43 years. Total frequency of fracture lines in the cohort was coronal - 26, proximal subchondral bone plate type - 24, avulsion - 19, sagittal - 16, and distal subchondral bone plate type - 11. There were statistically significantly more proximal than distal subchondral bone plate fractures ( p = 0.03), and more coronal fractures than distal subchondral bone plate fractures ( p = 0.01). There were statistically significantly more radiolunate ligament-avulsion types ( p <0.001) than other types. The sagittal fracture line through the lunate approximated closely to the ulnar edge of the capitate and the ulnar edge of the radius. Conclusion Study on the fracture morphology in the Kienbock's wrist has improved our understanding of the disease pathogenesis. Fracture lines may correspond to loading points, intrinsic and extrinsic ligament avulsions. These fracture types may play a role in disease progression and are important to identify when considering lunate salvage surgery.
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Affiliation(s)
- Simon B. M. MacLean
- Division of Orthopaedic and Upper Limb Surgeon, Department of Orthopaedic Surgery, Tauranga Hospital, New Zealand
| | - Gregory I. Bain
- Department of Hand and Upper Limb Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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Salva-Coll G, Esplugas M, Carreño A, Lluch-Bergada A. Kienböck's disease: preventing disease progression in early-stage disease. J Hand Surg Eur Vol 2023; 48:246-256. [PMID: 36799262 DOI: 10.1177/17531934221146851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Currently Kienböck's disease remains an 'unsolved' problem in hand surgery. Different factors have been associated with the avascular necrosis of the lunate. Mechanical, vascular and biological factors, alone or in combination, may have an influence in the aetiopathogenesis and determine the progress of the disease and even the results of the treatment. This is especially relevant in the early stages, in which conservative or surgical treatment may modify the natural history of the disease, maintaining the lunate structure and thus preserving the joint surfaces. There are multiple surgical treatments for Kienböck's disease in the early stages, before lunate collapse; each one is based on one of the possible factors that can cause avascular necrosis of the lunate. The objective is not only to treat symptoms but to prevent progression. This article is a review of the most frequent treatments used in the early stages and a personal view of the authors.Level of evidence: V.
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Affiliation(s)
- Guillem Salva-Coll
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
- Ibacma Institute, Balearic Institute for Hand Surgery, Palma de Mallorca, Illes Balears, Spain
| | - Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
| | - Ana Carreño
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain
| | - Alex Lluch-Bergada
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona
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Kariksiz M, Karakoyun O. Mid-term follow-up results of gradual capitate lengthening for the treatment of stage IIIA Kienbock's disease. J Orthop Surg (Hong Kong) 2023; 31:10225536231166205. [PMID: 36947646 DOI: 10.1177/10225536231166205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
PURPOSE This study aimed to evaluate the mid-term radiological and clinical results of gradual lengthening of capitate for the treatment of stage IIIA Kienbock's disease. METHODS We retrospectively reviewed nine patients (five females, four males) with Lichtman stage IIIA Kienbock's disease who underwent gradual capitate lengthening at our hospital. Their clinical (range of motion (ROM), grip strength, visual analogue scale (VAS) value for pain, and Mayo wrist score (MWS)) and radiological outcomes (in terms of progression of arthritis and carpal height ratio) at the last follow-up were compared to the preoperative values. RESULTS The mean age of the nine patients was 30 years (range: 20-38 years). The mean follow-up period was 73.8 (60-83) months. The average grip strength increased from 14.3 kg preoperatively to 22.3 kg at the last follow-up. The mean MWS increased from 58.8 preoperatively to 79.4 postoperatively. The mean VAS values decreased from the preoperative values: from 1.9 to 0.36 at rest, from 3.75 to 1.6 during mild effort, and from 5.35 to 3 during severe effort. The average carpal height ratio changed from 0.38 preoperatively to 0.53 postoperatively. None of the patients had any arthritic changes in their wrists. CONCLUSION Gradual lengthening of capitate offers satisfactory mid-term results for treating stage IIIA Kienbock's disease.
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Affiliation(s)
- Mesut Kariksiz
- Orthopedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ozgur Karakoyun
- Orthopedics and Traumatology, Ozgur Karakoyun private clinic, Tekirdag, Turkey
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9
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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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10
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Kienböck's disease in 2021. Orthop Traumatol Surg Res 2022; 108:103161. [PMID: 34861414 DOI: 10.1016/j.otsr.2021.103161] [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: 05/15/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
The cause of Kienböck's disease is still unclear. It was initially considered as osteomalacia, before being recognized as avascular necrosis of the lunate. Its functional prognosis is doubtful, given that the progression often leads to wrist degeneration. Conservative treatment does not provide good results in adults; thus surgery is often needed. Certain anatomical factors such as the ulnar variance, configuration of the lunate or orientation of the radial glenoid have turned out not to contribute to necrosis but may contribute to lunate fracture. The lunate's vascularization can be precarious and mostly depends on the capsular arterioles. The lunate is a very mobile bone that participates in wrist movements, both in the radiocarpal joint and especially in the mid-carpal joints during activities of daily living. Radiographs are not the only diagnostic tools. The lunate makes contact with the radius and triangular fibrocartilage complex and is often subjected to high shear loads at the edge of the radius that can cause it to fracture. MRI and arthroscopy can contribute to the assessment. Kienböck's disease is likely an inflammatory, biological venous thrombosis disorder that leads to local damage due to intraosseous compartment syndrome. The basis of surgical treatment is to decompress the lunate to shield it from shear and compression loads. Existing osteotomy procedures will be described and compared to better understand their biomechanical effects. Some osteotomies do not reduce the loads transmitted to the lunate but can reduce the risk of intra-osseous shear. Some osteotomies may place excessive pressure on the lunate on its ulnar side. Some techniques are extra-articular and preserve the capsule's vascularization along with the anatomy of the mid-carpal joint. When the lunate damage is so severe that the bone's viability is compromised, bone grafting or replacement have been proposed. The palliative techniques typically used for wrist degeneration are indicated in the terminal stages. There are currently no effective biological treatments. While the origin of Kienböck's disease is still unknown, we now know that decompression osteotomies, while they do not heal the necrosis, protect the lunate from collapse, which hopefully provides enough time for biological healing to occur.
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Cerezal L, Llopis E, Canga A, Piñal FD. Postoperative Imaging of Ulnar Wrist Pain. Semin Musculoskelet Radiol 2021; 25:329-345. [PMID: 34374067 DOI: 10.1055/s-0041-1731331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar wrist pain, caused by a broad spectrum of bone and soft tissue injuries, is the most common clinical condition of the wrist. Multiple surgical techniques and their variants in the treatment of these injuries are constantly evolving. Postoperative evaluation of the wrist for many surgeons is limited to serial clinical and radiographic monitoring. However, imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and arthrographic techniques (arthrographic CT and arthrographic MRI) play a fundamental role in diagnosing and managing postsurgical complications.The several critical aspects in evaluating the postsurgical wrist imaging spectrum are familiarity with the surgical techniques, knowledge of the original clinical problem, understanding the strength and limitations of the different radiologic modalities, and effective communication between surgeon and radiologist.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
| | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Ana Canga
- Department of Radiology, Marqués de Valdecilla University Hospital, Santander, Spain
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MacLean SBM, Bain GI. Kinematics of the wrist in Kienböck's disease: a four-dimensional computed tomography study. J Hand Surg Eur Vol 2021; 46:504-509. [PMID: 33491570 DOI: 10.1177/1753193420987790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied the kinematics of 20 wrists affected by Kienböck's disease using four-dimensional computed tomography (4-D-CT) scanning. Degenerative changes progressed from the lunate facet to the scaphoid fossa at the radiocarpal articulation, then involved the midcarpal joint. Lunate fracture types included coronal (14/20), sagittal (10/20) and ligament attachment-types (8/20). Findings specific to dynamic scanning included the nutcracker phenomenon (12/20), anterior radiolunate impingement (7/20), internal instability of the lunate (6/20), ulnar styloid triquetral impingement (3/20) and dynamic proximal row instability (2/20). Ulnocarpal translocation was found in 4/20 cases. Dynamic 4-D-CT has helped us to identify a subset of pathology in Kienböck's disease on assessment of static imaging. Better understanding of these phenomena can improve our understanding of symptoms and may help direct surgical treatment.Level of evidence: IV.
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Affiliation(s)
- Simon B M MacLean
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
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Aguilera RJ, Sanhueza CA. Update on the Use of Arthroscopy in Kienböck's Disease Management. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1721047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractKienböck's disease is a clinical-radiological condition that can permanently affect wrist functionality and the patient's quality of life. Proper, pertinent diagnosis and treatment are required to avoid salvage procedures. Arthroscopic techniques have emerged as an important tool for the treatment of certain stages of the disease.We present a review of the literature and propose a treatment algorithm according to the stage of the disease, including arthroscopic techniques. We detail the surgical technique of arthroscopic scaphocapitate arthrodesis, and the functional outcomes obtained by our group.
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Affiliation(s)
- René Jorquera Aguilera
- IWAS Faculty, IWC, Chile
- Orthopedics and Traumatology Department, Universidad Andrés Bello, Chile
- Hand Team, Artroscopia y Microcirugía Clínica Indisa, Santiago de Chile, Chile
| | - Camila Azócar Sanhueza
- Hand Team, Artroscopia y Microcirugía Clínica Indisa, Santiago de Chile, Chile
- Orthopedics and Traumatology Department, Universidad de Chile, Chile
- Hand Team, Hospital Clínico Mutual de Seguridad de Santiago de Chile, Chile
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Bain GI, Krishna SV, MacLean SBM, Agrawal P. Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease. J Wrist Surg 2020; 9:276-282. [PMID: 32760605 PMCID: PMC7395839 DOI: 10.1055/s-0040-1709669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
Background Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to "unload" the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease. This is a single-cut osteotomy with single-screw stabilization. Patients and Methods We have performed this technique in three cases. We present a case of a 26-year-old male who presented with a 1-year history of pain in his right wrist. Radiology performed demonstrated lunate sclerosis. Diagnostic arthroscopy revealed healthy articular surfaces. Single osteotomy capitate shortening was performed with an oscillating saw and fixed with a single cannulated compression screw. A shortening of 1.5mm was obtained with this technique. Results At 1- to 2-year follow-up, all three patients had considerable pain relief but did not have a complete resolution of pain. There was a significant improvement in function and grip strength. There have been no cases with infection, nonunion, avascular necrosis or a need for a salvage procedure. Conclusion The simplified technique of capitate shortening is easy to perform, less traumatic to the capitate vascularity, and leads to good short-term functional results.
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Affiliation(s)
- Gregory I. Bain
- Department of Orthopedic Surgery and Trauma, Flinders University, Adelaide, Australia
- Department of Orthopedic Surgery and Trauma, Flinders Medical Center, Adelaide, Australia
| | - Sathya Vamsi Krishna
- Department of Orthopedic Surgery and Trauma, Flinders Medical Center, Adelaide, Australia
| | | | - Parth Agrawal
- Department of Orthopedic Surgery and Trauma, Flinders Medical Center, Adelaide, Australia
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Kienböck's disease: Where do we stand? J Clin Orthop Trauma 2020; 11:606-613. [PMID: 32684697 PMCID: PMC7355093 DOI: 10.1016/j.jcot.2020.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 11/21/2022] Open
Abstract
Avascular necrosis of the lunate, commonly known as Kienböck's disease is a disorder that can lead to carpal collapse and the need for surgeries, which can stabilize the wrist. There are different associations with the disease but the exact etiology is unknown. Kienböck's disease is believed to result from mechanical and vascular factors in genetically predisposed individuals. The newer classification based on advanced wrist arthroscopy and MRI help in a better understanding of the disease, early diagnosis, and treatment. A review of recent literature regarding newer treatment options has shown good results in the early stages of osteonecrosis. This article intends to review an update on the etiopathogenesis, classification, and the current advanced treatment options.
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Kazmers NH, Yu Z, Barker T, Abraham T, Romero R, Jurynec MJ. Evaluation for Kienböck Disease Familial Clustering: A Population-Based Cohort Study. J Hand Surg Am 2020; 45:1-8.e1. [PMID: 31761504 PMCID: PMC6943177 DOI: 10.1016/j.jhsa.2019.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/15/2019] [Accepted: 10/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Kienböck disease (KD) is rare and its etiology remains unknown. As a result, the ideal treatment is also in question. Our primary purpose was to test the hypothesis that KD would demonstrate familial clustering in a large statewide population with comprehensive genealogical records, possibly suggesting a genetic etiologic contribution. Our secondary purpose was to evaluate for associations between KD and known risk factors for avascular necrosis. METHODS Patients diagnosed with KD were identified by searching medical records from a comprehensive statewide database, the Utah Population Database. This database contains pedigrees dating back to the early 1800s, which are linked to 31 million medical records for 11 million patients from 1996 to the present. Affected individuals were then mapped to pedigrees to identify high-risk families with an increased incidence of KD relative to control pedigrees. The magnitude of familial risk of KD in related individuals was calculated using Cox regression models. Association of risk factors related to KD was analyzed using conditional logistic regression. RESULTS We identified 394 affected individuals linked to 194 unrelated high-risk pedigrees with increased incidence of KD. The relative risk of developing KD was significantly elevated in first-degree relatives. There was a significant correlation between alcohol, glucocorticoid, and tobacco use and a history of diabetes, and the diagnosis of KD. CONCLUSIONS Familial clustering of KD observed in the Utah Population Database cohort indicates a potential genetic contribution to the etiology of the disease. Identification of causal gene variants in these high-risk families may provide insight into the genes and pathways that contribute to the onset and progression of KD. CLINICAL RELEVANCE This study suggests that there is a potential genetic contribution to the etiology of KD and that the disease has a significant association with several risk factors.
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Affiliation(s)
| | - Zhe Yu
- Utah Population Database Resource, Huntsman Cancer Institute, Salt Lake City, UT
| | - Tyler Barker
- Intermountain Healthcare, Precision Genomics, Murray, UT; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Tyler Abraham
- Intermountain Healthcare, Precision Genomics, St George, UT
| | - Robin Romero
- Intermountain Healthcare, Precision Genomics, St George, UT
| | - Michael J Jurynec
- Department of Orthopaedics, University of Utah, Salt Lake City, UT; George and Dolores Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT
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Dharmshaktu GS. Osseous tuberculosis mimicking Kienböck's disease of the wrist. Eur J Rheumatol 2019; 6:165-166. [PMID: 31364985 DOI: 10.5152/eurjrheum.2018.18102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022] Open
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Müller G, Månsson S, Müller MF, Johansson M, Björkman A. Increased perfusion in dynamic gadolinium-enhanced MRI correlates with areas of bone repair and of bone necrosis in patients with Kienböck's disease. J Magn Reson Imaging 2018; 50:481-489. [PMID: 30556360 DOI: 10.1002/jmri.26573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteonecrosis of the lunate, Kienböck's disease, can lead to fragmentation of the lunate, carpal collapse, and severe osteoarthritis. Since the etiology of Kienböck's disease is impaired circulation, a diagnostic method capable of assessing perfusion would be valuable. Recent studies have suggested that dynamic contrast-enhanced (DCE) MR examinations at 3 T can assess perfusion in healthy carpal bones. PURPOSE To evaluate the use of DCE-MR for assessing perfusion in the lunate bone in patients with Kienböck's disease. Furthermore, to compare perfusion with histopathology with a focus on bone viability. STUDY TYPE Prospective case-control study. POPULATION Fourteen patients with Kienböck's disease and a control group of 19 healthy subjects. Field Strength: 3 T with T1 -weighted fat-saturated contrast-enhanced gradient echo series. ASSESSMENT Features of the enhancement curves from the DCE-MR examinations, time to peak (TTP), maximum slope (MS), and maximum enhancement (ME) assessed by a radiologist. Six of 14 patients were surgerized with lunate excision, allowing comparison between features of the enhancement curves and histopathology. STATISTICAL TESTS Mann-Whitney U-test. P < 0.05 was considered a statistically significant difference. RESULTS Patients with Kienböck's disease showed significantly higher and faster perfusion parameters compared with the control group, the mean value of the TTP in patients was 126.73 sec, in controls 189.79 sec (P = 0.024), ME in patients 173.55 AU, in controls 28.46 AU (P < 0.001), and MS in patients 5.04 AU, in controls 1.06 AU (P < 0.001). When compared with histopathology, increased perfusion was seen in areas of bone formation but also in necrosis. Areas of normal bone showed low perfusion. DATA CONCLUSION DCE-MRI at 3 T can diagnose altered perfusion in patients with Kienböck's disease. Increased perfusion cannot definitely be used as a marker of bone viability. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:481-489.
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Affiliation(s)
| | - Sven Månsson
- Department of Medical Radiation Physics, Lund University, Malmö, Sweden
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Ichinose H, Nakamura R, Nakao E, Shinohara T, Tatebe M, Yamada H. Wrist Swelling in Kienböck's Disease. J Wrist Surg 2018; 7:389-393. [PMID: 30349751 PMCID: PMC6196096 DOI: 10.1055/s-0038-1661420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.
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Affiliation(s)
- Hirofusa Ichinose
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | | | | | - Masahiro Tatebe
- Department of Hand Surgery, School of Medicine, Nagoya University, Nagoya, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Yesiloz M, Louis M, DeVerbizier J, Dautel G, Dap F, Blum A, Teixeira PG. Kienböck's disease: Role of cross-sectional imaging in treatment choice and patient follow-up. Eur J Radiol 2018; 105:269-282. [PMID: 30017293 DOI: 10.1016/j.ejrad.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/09/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Abstract
The management of Kienböck's disease is complex and constantly evolving in parallel with progress in the understanding of the pathophysiological mechanisms of this condition. Cross-sectional imaging techniques have an essential role in the diagnosis and prognostic assessment of this disease. CT allows the optimal study of the morpho-structure of lunate bone. MRI makes it possible to study bone marrow viability. As for CT arthrography, it allows to evaluate accurately articular cartilage of the different carpal joints. The evaluation of these different aspects of Kienböck's disease is essential for optimal treatment selection. Cross-sectional imaging also has an interest in post-treatment follow-up, by having a prognostic value and allowing the identification of post-operative complications. The purpose of this article is to review the contribution of cross-sectional imaging in the assessment of Kienböck's disease before and after treatment according to the most common surgical procedures. Pathophysiological mechanisms, predisposing factors, the different classifications and their interests will be discussed.
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Affiliation(s)
- Muhammed Yesiloz
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - Matthias Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Jacques DeVerbizier
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Gilles Dautel
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - François Dap
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - Alain Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
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