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Tee R, Butler S, Ek ET, Tham SK. Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease. J Wrist Surg 2024; 13:294-301. [PMID: 39027019 PMCID: PMC11254482 DOI: 10.1055/s-0043-1778064] [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: 09/11/2023] [Accepted: 12/05/2023] [Indexed: 07/20/2024]
Abstract
Background In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy. Materials and Methods We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD. Results We put forward an investigative algorithm that places into context the investigative roles of MRI, arthroscopy, and CT. Conclusion KD is a rare condition, and there is a lack of comparative studies to help us choose the preferred treatment. The decision on the management options in adult KD may be made by determining the integrity of the lunate cortex and deciding whether the lunate is salvageable or not by CT scan. MRI may provide useful information on the vascular status if the lunate cortex is intact, and the lunate is salvageable. If the lunate is fragmented, it is not salvageable, and MRI does not provide useful information. Arthroscopy has a role in selective cases.
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Affiliation(s)
- Richard Tee
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Stephen Butler
- Department of Plastic and Hand Surgery, St Vincents Hospital, Fitzroy, Victoria, Australia
| | - Eugene T. Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, Victoria, Australia
| | - Stephen K. Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
- Department of Plastic and Hand Surgery, St Vincents Hospital, Fitzroy, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, Victoria, Australia
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2
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Florczynski MM, Chung KC. Choosing the Best Design in Surgical Research. Plast Reconstr Surg 2023; 151:1115-1122. [PMID: 37224338 DOI: 10.1097/prs.0000000000010173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Matthew M Florczynski
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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Daly CA, Graf AR. Kienböck Disease: Clinical Presentation, Epidemiology, and Historical Perspective. Hand Clin 2022; 38:385-392. [PMID: 36244706 DOI: 10.1016/j.hcl.2022.03.002] [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
In the now 110 years that have passed since Kienböck first published his seminal description of lunate osteonecrosis, improvements in imaging technology and surgical technique have provided a better understanding of Kienböck disease pathogenesis and treatment. However, the precise etiology, natural history, and optimal treatment remain controversial. Future studies examining the genetics behind the disease and large-scale prospective studies comparing treatment options represent the next step in improving our understanding of this rare and complex phenomenon.
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Affiliation(s)
- Charles Andrew Daly
- Department of Orthopaedic Surgery, Division of Upper Extremity Surgery, Medical University of South Carolina, Medical University of South Carolina Orthopaedics, 96 Jonathan Lucas Street, MSC Code: 708, Charleston, SC 29425, USA.
| | - Alexander Reed Graf
- Department of Orthopedic Surgery, Division of Upper Extremity Surgery, Emory University, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA 30329, USA.
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Wang PQ, Matache BA, Grewal R, Suh N. Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review. J Wrist Surg 2020; 9:535-548. [PMID: 33282541 PMCID: PMC7708034 DOI: 10.1055/s-0040-1716353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/14/2020] [Indexed: 01/07/2023]
Abstract
Background Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. Purpose This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. Methods A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. Results A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. Conclusion In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.
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Affiliation(s)
- Patrick Q. Wang
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Bogdan A. Matache
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
| | - Ruby Grewal
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
| | - Nina Suh
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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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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Shin YH, Kim JK, Han M, Lee TK, Yoon JO. Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review. J Bone Joint Surg Am 2018; 100:1231-1240. [PMID: 30020130 DOI: 10.2106/jbjs.17.00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease. METHODS We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies. RESULTS Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°). CONCLUSIONS Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young Ho Shin
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Kwang Kim
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minkyu Han
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Kyoon Lee
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun O Yoon
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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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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8
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Abstract
BACKGROUND With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient. METHODS We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock's disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013. RESULTS Twelve patients were included with a mean age of 41.6 years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1 months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20-110°). The average ulnar deviation was 9° (range 5-15°), and the average radial deviation was 13° (range 5-25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05). CONCLUSIONS Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease.
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Affiliation(s)
- Matthew L. Iorio
- Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA USA
| | - Colin D. Kennedy
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
| | - Jerry I. Huang
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
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Stahl S, Hentschel PJH, Santos Stahl A, Meisner C, Schaller HE, Manoli T. Comparison of clinical and radiologic treatment outcomes of Kienböck's disease. J Orthop Surg Res 2015; 10:133. [PMID: 26306571 PMCID: PMC4550042 DOI: 10.1186/s13018-015-0276-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/09/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose The clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck’s disease (KD) progression exists. Methods Out of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups. Results There were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant. Conclusions The study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease. Level of evidence Therapy, level III, retrospective comparative study with prospectively collected data.
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Affiliation(s)
- Stéphane Stahl
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Pascal J H Hentschel
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Adelana Santos Stahl
- Department for Plastic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany.
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University of Tübingen, Silcherstr. 5, 9572076, Tübingen, Germany.
| | - Hans-Eberhard Schaller
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Theodora Manoli
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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10
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Critical Analysis of Causality between Negative Ulnar Variance and Kienböck Disease. Plast Reconstr Surg 2013; 132:899-909. [DOI: 10.1097/prs.0b013e31829f4a2c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Sando IC, Malay S, Chung KC. Analysis of publication bias in the literature for distal radius fracture. J Hand Surg Am 2013; 38:927-934.e5. [PMID: 23566720 PMCID: PMC3667615 DOI: 10.1016/j.jhsa.2013.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius fractures are the most commonly treated fracture, and their management remains complex. We aimed to evaluate the presence of publication bias in the literature on distal radius fracture management and to identify specific study variables that may influence the reporting of positive outcomes. METHODS We conducted a systematic review on all available journal articles to find primary articles reporting on the management of distal radius fractures. Data collected included the direction of study outcome (positive, neutral, and negative) and various study characteristics including sample size, geographic origin of the study, clinical setting, study design, type of treatment, analysis for statistical significance, evaluation of wrist function, presence of subjective outcome measures, mean follow-up time, adequacy of reduction, complications, mean patient age, and the presence of any extramural funding. RESULTS We reviewed 215 journal articles and found that 70% of articles reported positive outcomes, 25% reported neutral outcomes, and 5% reported negative outcomes. Funnel plot analysis suggested the presence of publication bias depicted by the asymmetric distribution of studies. In addition, we found statistically significant differences between study outcomes with respect to treatment type, presence of external funding, reduction adequacy, hand/wrist functional assessment, and patient questionnaires for subjective assessment. CONCLUSIONS Publication bias likely exists in the literature for distal radius fracture management. Several study characteristics influence the reporting of positive outcomes, but whether the presence of these characteristics portends a greater chance of publication remains unclear. A standardized approach to measure and track results may improve evidence-based outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Ian C Sando
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Sunitha Malay
- Clinical Research Coordinator, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
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Stahl S, Stahl AS, Meisner C, Rahmanian-Schwarz A, Schaller HE, Lotter O. A systematic review of the etiopathogenesis of Kienböck's disease and a critical appraisal of its recognition as an occupational disease related to hand-arm vibration. BMC Musculoskelet Disord 2012; 13:225. [PMID: 23171057 PMCID: PMC3559259 DOI: 10.1186/1471-2474-13-225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 10/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We systematically reviewed etiological factors of Kienböck's disease (osteonecrosis of the lunate) discussed in the literature in order to examine the justification for including Kienböck's disease (KD) in the European Listing of Occupational Diseases. METHODS We searched the Ovid/Medline and the Cochrane Library for articles discussing the etiology of osteonecrosis of the lunate published since the first description of KD in 1910 and up until July 2012 in English, French or German. Literature was classified by the level of evidence presented, the etiopathological hypothesis discussed, and the author's conclusion about the role of the etiopathological hypothesis. The causal relationship between KD and hand-arm vibration was elucidated by the Bradford Hill criteria. RESULTS A total of 220 references was found. Of the included 152 articles, 140 (92%) reached the evidence level IV (case series). The four most frequently discussed factors were negative ulnar variance (n=72; 47%), primary arterial ischemia of the lunate (n=63; 41%), trauma (n=63; 41%) and hand-arm vibration (n=53; 35%). The quality of the cohort studies on hand-arm vibration did not permit a meta-analysis to evaluate the strength of an association to KD. Evidence for the lack of consistency, plausibility and coherence of the 4 most frequently discussed etiopathologies was found. No evidence was found to support any of the nine Bradford Hill criteria for a causal relationship between KD and hand-arm vibration. CONCLUSIONS A systematic review of 220 articles on the etiopathology of KD and the application of the Bradford Hill criteria does not provide sufficient scientific evidence to confirm or refute a causal relationship between KD and hand-arm vibration. This currently suggests that, KD does not comply with the criteria of the International Labour Organization determining occupational diseases. However, research with a higher level of evidence is required to further determine if hand-arm vibration is a risk factor for KD.
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Affiliation(s)
- Stéphane Stahl
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, Tübingen, 72076, Germany
| | - Adelana Santos Stahl
- Department for Plastic Surgery, Marienhospital Stuttgart, Böheimstr. 37, Stuttgart 70199, Germany
| | - Christoph Meisner
- Department of Medical Biometry, Eberhard-Karl University of Tübingen, Westbahnhofstr. 55, Tübingen, 72070, Germany
| | - Afshin Rahmanian-Schwarz
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, Tübingen, 72076, Germany
| | - Hans-Eberhard Schaller
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, Tübingen, 72076, Germany
| | - Oliver Lotter
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, Tübingen, 72076, Germany
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13
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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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Amadio PC. What's new in hand surgery. J Bone Joint Surg Am 2011; 93:985-9. [PMID: 21593378 DOI: 10.2106/jbjs.j.01752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
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