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Ye X, Feng JT, Yin HW, Qiu YQ, Shen YD, Xu WD. Use of 4+5 extensor compartmental vascularized bone graft and K-wire fixation for treating stage II-IIIA Kienböck's disease. HAND SURGERY & REHABILITATION 2020; 39:207-213. [PMID: 32070791 DOI: 10.1016/j.hansur.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
Vascularized bone grafts have shown favorable outcomes in Kienböck's disease, preventing the progression of lunate collapse and avascular necrosis. Here we describe our experience using a 4+5 extensor compartmental artery (ECA) vascularized bone graft combined with K-wire fixation. Between September 2010 and June 2013, 9 patients with Lichtman stage II-IIIA disease underwent arthroscopy prior to 4+5 ECA graft placement combined with temporary fixation (scaphocapitate and triquetrum-capitate joints). The average follow-up was 69 months (range, 51-92 months). Changes in pain, range of motion, grip strength, and pinch strength were analyzed. All patients had satisfactory recovery, especially pain relief and grip strength improvement (both P<0.01). Furthermore, magnetic resonance imaging follow-up was critical for monitoring lunate revascularization, especially in the early postoperative period.
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Affiliation(s)
- X Ye
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - J-T Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - H-W Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - Y-Q Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China
| | - Y-D Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China.
| | - W-D Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Fudan University, 138, Yixueyuan road, 200032 Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, 138, Yixueyuan road, 200032 Shanghai, China
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Kim S, Eichenauer F, Asmus A, Mutze S, Eisenschenk A, Honigmann P. Superselective angiography of the wrist in patients with Kienböck's disease. BMC Musculoskelet Disord 2019; 20:143. [PMID: 30947704 PMCID: PMC6449992 DOI: 10.1186/s12891-019-2492-5] [Citation(s) in RCA: 1] [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] [Received: 03/23/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microvascular problems like increased intraosseous pressure or venous congestion may influence the development of Kienböck's disease. We examined if wrist position modifies the blood flow in the nutrient vessels. METHODS Retrospective analysis of 17 patients with Kienböck's disease who had a superselective microangiography of the radial, ulnar and interosseous artery in different wrist positions under general anaesthesia. We analysed the data with Fisher's exact and Wilcoxon-test. RESULTS We found vessels that entered the bone, that ended at the bone edge, and that supplied a vascular plexus. The origins were the anterior interosseous artery in 10 of 17 cases, the radial artery in seven cases, and the ulnar artery in five cases. Movement of the wrist could reduce or stop the blood flow. Type of lunate configuration showed no significant influence on the blood supply in neutral position. CONCLUSION The radial, ulnar, and anterior interosseous artery contribute to the vascular supply of the lunate bone in different combinations. Wrist movement can reduce blood flow to the lunate bone.
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Affiliation(s)
- S Kim
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany. .,Klinik und Poliklinik für Unfallchirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - F Eichenauer
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - A Asmus
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - S Mutze
- Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - A Eisenschenk
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Klinik und Poliklinik für Unfallchirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - P Honigmann
- Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
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Stenekes MW, Nicolai JPA. What to do with non-replanted hands? SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 2009; 43:61-63. [PMID: 19153886 DOI: 10.1080/02844310701270190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We describe a method for the preparation of amputated limbs to obtain a specimen for anatomical study of the arteries and the skeleton. The procedure is particularly applicable to hands, and prevents the destruction of a perfect hand that cannot be replanted.
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Affiliation(s)
- Martin Willian Stenekes
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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