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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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Chappell AG, Ramsey MD, Dabestani PJ, Ko JH. Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review. Arch Plast Surg 2023; 50:82-95. [PMID: 36755653 PMCID: PMC9902088 DOI: 10.1055/s-0042-1758639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/04/2022] [Indexed: 02/09/2023] Open
Abstract
Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Parinaz J. Dabestani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence Jason H. Ko, MD, MBA, Associate Professor, Program Director Plastic Surgery Residency, Division of Plastic and Reconstructive SurgeryDepartment of Orthopedic Surgery, Northwestern University Feinberg School of MedicineChicago, IL 60611
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Pickrell BB, Harper CM. Avascular Necrosis of Capitate and Other Uncommon Presentations of Carpal Avascular Necrosis. Hand Clin 2022; 38:479-485. [PMID: 36244715 DOI: 10.1016/j.hcl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outside of Preiser and Kienbock disease, avascular necrosis (AVN) of the remaining carpal bones is a rare cause of wrist pain and disability with a natural history that is incompletely understood. At present, much of the available clinical information exists in the form of isolated case reports or small case series. Although reported surgical treatment options are numerous, there is a dearth of comparative studies and long-term outcomes data with which to guide management.
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Affiliation(s)
- Brent B Pickrell
- Department of Orthopedic Surgery, 330 Brookline Avenue-Stoneman 10, Boston, MA 02215, USA
| | - Carl M Harper
- Department of Orthopedic Surgery, 330 Brookline Avenue-Stoneman 10, Boston, MA 02215, USA.
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Chojnowski K, Opiełka M, Piotrowicz M, Sobocki BK, Napora J, Dąbrowski F, Piotrowski M, Mazurek T. Recent Advances in Assessment and Treatment in Kienböck's Disease. J Clin Med 2022; 11:jcm11030664. [PMID: 35160115 PMCID: PMC8836398 DOI: 10.3390/jcm11030664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/17/2022] Open
Abstract
Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.
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Wang PQ, Charron BP, Chan KTK, Grewal R, Suh N. Potential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review. Hand (N Y) 2022; 18:6S-16S. [PMID: 35043699 PMCID: PMC10052625 DOI: 10.1177/15589447211066613] [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: 11/17/2022]
Abstract
BACKGROUND The purpose of this systematic review is to identify whether non-salvage procedures can provide satisfactory and acceptable outcomes in Lichtman stage IV disease. METHODS The MEDLINE, Embase, and Cochrane databases were systematically searched for English publications between 1989 and 2019 that reported stage IV-specific primary treatment outcomes. Revisions and skeletally immature patients were excluded. Data extracted were patient demographics, pain scores, range of motion (ROM), grip strength, and patient-reported outcome measures (PROMs). The results were pooled into 3 categories: conservative management, non-salvage, and salvage procedures. RESULTS Data from 24 studies (n = 114 patients) were extracted. Compared with conservative management and non-salvage treatment (joint-leveling radial osteotomies, lunate reconstruction), salvage procedures (intercarpal and radiocarpal arthrodesis, proximal row carpectomy, total wrist arthroplasty) showed significantly decreased ROM in flexion-extension arc of motion (89° vs 95° vs 73°, respectively, P = .0001) and no significant differences in grip strength as a percentage of the contralateral side (83% vs 86% vs 79%, respectively, P = .28). All reported treatments provided pain relief, ability to return to previous occupations, and variable PROMs. CONCLUSIONS In young, active, and labor-intensive patients, motion-preserving, non-salvage options may be worth trialing as they do not preclude future salvage options.
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Affiliation(s)
| | | | - Kevin T K Chan
- Spectrum Health/Michigan State University, Grand Rapids, USA
| | - Ruby Grewal
- Western University, London, ON, Canada.,St. Joseph's Health Care London, ON, Canada
| | - Nina Suh
- Western University, London, ON, Canada.,St. Joseph's Health Care London, ON, Canada
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Orman O, Eren F, Kara AD, Cesur C, Yıldırım C, Aysal BK. A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series. Jt Dis Relat Surg 2021; 32:504-513. [PMID: 34145830 PMCID: PMC8343860 DOI: 10.52312/jdrs.2021.79298] [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: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to describe our surgery technique and discuss patients treated through the dorsoulnar artery (DUA)-based technique of osseous and osteo-fascio-cutaneous vascularized ulnar bone grafting. Patients and methods
Between January 2011 and January 2015, six male patients (median age: 22.5 years; range, 20 to 24 years) who underwent surgery during which the technique of DUA ulnar bone graft was utilized. One patient with scaphoid nonunion, three patients with Kienböck’s disease, and two patients with a traumatic metacarpal defect were retrospectively evaluated. The joint range of motion (ROM), grip strength, Disabilities of the arm, shoulder and Hand (DASH) questionnaire score and Visual Analog Scale (VAS) score, and radiographies before and after surgery were examined. Scintigraphy was performed at 12 weeks postoperatively to monitor the viability of the bone graft. Results
All patients showed improvements in the ROM, grip strength, VAS, and DASH scores. According to the radiographic examination, bone union was achieved in all patients and the scintigraphy revealed that vascularization was detected in the bone tissue. Conclusion
The advantages of DUA-based vascularized bone graft are good bone quality and quantity and versatility due to its long pedicle. The osteo-fasio-cutaneous DUA flap seems to be effective in the treatment of traumatic metacarpal bone defects accompanied by skin loss. The DUA-based vascularized ulnar bone may be a source for scaphoid and lunate biological bone reconstruction.
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Affiliation(s)
- Osman Orman
- İstanbul Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi, El Cerrahisi Kliniği, 3447 Sarıyer, İstanbul, Türkiye.
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许 育, 徐 永, 罗 浩, 何 晓, 张 旭, 赵 万, 吴 欢, 袁 礼. [Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:596-601. [PMID: 32410427 PMCID: PMC8171847 DOI: 10.7507/1002-1892.201907128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/24/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique. METHODS Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. RESULTS There were significant differences in the longitudinal and transverse diameters between pisiform and lunate ( t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness ( t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side ( P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides ( P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch ( P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch ( P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch ( P>0.05). But the differences between the other vascular pedicles were significant ( P<0.05). CONCLUSION There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck's disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.
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Affiliation(s)
- 育健 许
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 永清 徐
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 浩天 罗
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 晓清 何
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 旭林 张
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 万秋 赵
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 欢 吴
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - 礼波 袁
- 陆军军医大学研究生院(重庆 400000)The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
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