Lunate fracture healing after partial capitate shortening in Kienböck disease

Analyzing Chronological Change in Postoperative Magnetic Resonance Imaging Results in Patients With Kienböck’s Disease by Using an Original Grading System

Background and objective

Signal changes in MRI for Kienböck’s disease have only been qualitatively assessed so far. In light of this, we proposed a new grading system for quantitative analysis with an ordinal scale.

Methods

The study included 31 patients (17 men, 14 women) with Kienböck's disease. By referring to Nakamura’s MRI grading system, we devised a grading system with five grades (Grades 1-5) using proton density-weighted (PDW) coronal images with respect to the signal intensity of the lunate. All cases were examined by using the MRI grading system by three hand surgeons, both preoperatively and postoperatively. We evaluated the inter-rater reliability of our grading system by using the interclass correlation coefficient. After surgery, we implemented annual MRI evaluation for as long as possible and quantitatively assessed changes in MRI grades. We also investigated the correlation between postoperative MRI grades, Mayo Wrist Scores (MWS), and age at the surgery by using Pearson’s coefficient.

Results

The MRI evaluation was performed 2-15 years after surgery. The reliability of our grading system was high; inter-rater interclass correlation coefficients were 0.783 (examiners 1-2), 0.780 (examiners 1-3), and 0.825 (examiners 2-3), representing a substantial agreement. The correlation coefficient between the MRI grade and MWS was -0.31, suggesting a mild negative correlation; postoperative MRI grade also correlated with age at surgery (Pearson’s coefficient: 0.447).

Conclusions

Our proposed MRI grading system has high reliability and could be used to assess the regeneration of a necrotic lunate for quantitative analysis on an ordinal scale. Improvements were observed one to four years postoperatively, demonstrating a mild correlation with the clinical results.

Potential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review

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.