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Hegazy G, Seddik M, Massoud AH, Imam R, Alshal E, Zayed E, Darweash A. Capitate shortening osteotomy with or without vascularized bone grafting for the treatment of early stages of Kienböck's disease. INTERNATIONAL ORTHOPAEDICS 2021; 45:2635-2641. [PMID: 34264352 DOI: 10.1007/s00264-021-05103-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The study evaluates the procedures of capitate shortening osteotomy with or without vascularized bone grafting (VBG) for the treatment of stage II or IIIA Kienböck's disease with neutral ulnar variance. METHOD Forty-five patients with stage II (n = 21) and IIIA (n = 24) Kienböck's disease were included in the study. Patients were classified into two groups; isolated capitate shortening (ICS) group included 21 patients (stage II [n = 10] and stage IIIA [n = 11]) treated by capitate shortening without VBG of the lunate. Combined capitate shortening (CCS) group includes 24 patients (stage II [n = 11] and stage IIIA [n = 13]) who treated by capitate shortening combined with VBG of the lunate from the dorsal distal radius based on the fourth + fifth extensor compartment artery. All patients were evaluated pre- and post-operative for pain as measured by visual analogue scale score (VAS), range of motion (ROM), grip strength, modified Mayo wrist score (MMWS), lunate height index (LHI) ratio, and carpal height index (CHI) ratio. RESULTS The mean operative time for CCS procedure was 85 min (76 to 120) and for ICS was 58 min (47 to 65). The mean follow-up period for all patients was 33 months (29 to 47). Patients with stage IIIA Kienböck's disease treated by CCS procedure had better post-operative VAS, ROM, grip strength, MMWS, LHI, and CHI ratio than patients treated by ICS procedure. ICS procedure reported 28% failure rate versus 8% for CCS. No differences were found between CCS and ICS procedures in patients with stage II Kienböck's disease in the term of clinical, radiographic outcomes, or failure rate. CONCLUSION Using CCS procedure for the treatment of stage IIIA Kienböck's disease (lunate height collapse) with neutral ulnar variance can restore height and dimensions of the collapsed lunate and subsequently improve the final outcomes with lower failure rate. However, in patients with stage II Kienböck's disease (maintained lunate height), no advantages were noticed for CCS over ICS procedure. Lunate height index might be considered a prognostic factor for the treatment outcomes of Kienböck's disease.
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Affiliation(s)
- Galal Hegazy
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt.
| | - Mahmoud Seddik
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Abdel-Hakim Massoud
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Rashed Imam
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Ehab Alshal
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut CityAssiut, 71524, Egypt
| | - Emad Zayed
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt
| | - Ahmed Darweash
- Orthopedic Department, Faculty of Medicine, Suez University, El Salam CitySuez, 43533, Egypt
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Henry M, Lundy FH, Henry GK. Matching Kienböck's Treatment Options to Specific Features of Each Case. J Hand Microsurg 2021; 15:87-97. [PMID: 37020608 PMCID: PMC10070007 DOI: 10.1055/s-0041-1730888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck's patients through the early, transitional, and late phases of the disease.
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Affiliation(s)
- Mark Henry
- Hand and Wrist Center of Houston, Houston, Texas, United States
- Address for correspondence Mark Henry, MD Hand and Wrist Center of Houston1200 Binz Street, Suite 1390, Houston TX - 77004United Sates
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Kayaokay K, Ozcan C, Bulut T, Gursoy M, Dirim Mete B. Radial shortening osteotomy vs partial capitate shortening osteotomy in Kienböck's disease: Medium-term radiological and clinical results. HAND SURGERY & REHABILITATION 2021; 40:427-432. [PMID: 33775890 DOI: 10.1016/j.hansur.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease progression in patients with stage II or IIIA Kienböck's disease. Patients who underwent surgery for Kienböck's disease between March 2010 and July 2020 were retrospectively evaluated. Clinical evaluation included assessment of pain, joint range of motion, strength, DASH, visual analog scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), satisfaction and time to return to work, with comparison as appropriate to the contralateral side. Preoperative and postoperative plain radiographs and magnetic resonance imaging (MRI) were used for radiological evaluation. Lichtman staging and signal changes in the lunate were evaluated using MRI. Group 1 (PCS) included 14 patients and Group 2 (RS) 14. Mean follow-up was 57.8 months (range 24-102) in Group 1 and 49.4 months (range 36-73) in Group 2. Clinical evaluation included pain on VAS, DASH score, MMWS, range of motion, and grip, palmar and key pinch strength. Regarding lunate bone vascularization, increased signal on final follow-up MRI was observed in 10 of the 14 patients in Group 1 and 7 of the 14 patients in Group 2. There was a positive correlation between revascularization and final follow-up MMWS (p = 0.006). The present study thus showed that functional scores were improved by revascularization in Kienböck's disease. Both osteotomies had clinically and radiologically satisfactory results. However, we believe that PCS osteotomy is preferable, as it leads to higher revascularization rates without increasing ulnolunate load.
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Affiliation(s)
- K Kayaokay
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey.
| | - C Ozcan
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - T Bulut
- Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - M Gursoy
- Department of Radiology, Faculty of Medicine, Izmir Democracy University, Ozmen Cd. 35390 No: 147, Buca, Izmir, Turkey
| | - B Dirim Mete
- Department of Radiology, Faculty of Medicine, Izmir Democracy University, Ozmen Cd. 35390 No: 147, Buca, Izmir, Turkey
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Lunate biomechanics: application to Kienböck's disease and its treatment. HAND SURGERY & REHABILITATION 2020; 40:117-125. [PMID: 33309792 DOI: 10.1016/j.hansur.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/20/2023]
Abstract
Kienböck's disease was initially considered as lunate osteomalacia due to lesions of its nutrient arteries during carpal ligament tears. It has also been suggested following primary fractures, or because of repeated microtrauma. It is only in the past 20 or 30 years that it has appeared as aseptic necrosis. Based on Hultén's hypothesis that a negative radioulnar index was the cause of Kienböck's disease, equalization osteotomies (shortening of the radius or lengthening of the ulna) were developed. The observation of Kienböck's disease in subjects with a positive index and the risk of ulnar abutment after osteotomy led to the introduction of new osteotomies to get around these difficulties, still in the hope of treating the cause of Kienböck's disease. While it has been confirmed that a negative radioulnar index promotes lunate fracture, it clearly does not induce the pathology in the form of necrosis. In this scenario, perilunar osteotomies produce durable decompression, limiting the risk of lunate fracture in case of necrosis by removing the compressive constraints. After comparing the different osteotomies used to treat Kienböck's disease, it seems that the Camembert osteotomy for radius shortening, combined with selective shortening of the ulnar head as described by Sennwald, decompresses the lunate maximally, and protects it long enough for potential natural revascularization to occur.
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Camus EJ, Aimar A, Van Overstraeten L, Schuind F, Innocenti B. Lunate loads following different osteotomies used to treat Kienböck's disease: A 3D finite element analysis. Clin Biomech (Bristol, Avon) 2020; 78:105090. [PMID: 32562880 DOI: 10.1016/j.clinbiomech.2020.105090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of most accepted principles for treating Kienböck's disease before wrist degeneration settles in is to decompress the lunate by an osteotomy. Several osteotomies have been proposed since 1935. However, they are based on biomechanical hypotheses that are sometimes conflicting: This study compares the decompression effect of radius transverse shortening, radius lateral closing and medial closing wedge osteotomies, capitate shortening - with and without hamate shortening - and a Camembert-type radius wedge osteotomy with and without ulnar head shortening according to Sennwald. METHODS We built a 3D wrist model using finite elements that included the metacarpal, carpal and forearm bones. All wrist ligaments and Triangular Fibrocartilage Complex were incorporated in the simulation. Load was applied on the metacarpals with the forearm bones fixed. We then applied the different osteotomies to the model. FINDINGS When load was applied to the wrist, the osteotomies that best unloaded the lunate were the capitate shortening osteotomy combined with hamate shortening and the Camembert osteotomy combined with ulna shortening; the latter was the only osteotomy that completely unloaded the lunate. INTERPRETATION We think the association of the radius Camembert osteotomy and ulna Sennwald's shortening osteotomy is the most effective procedure to propose in Kienböck's disease.
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Affiliation(s)
- Emmanuel J Camus
- SELARL Chirurgie de la main et du pied, 94bis rue Gustave Delory, 59810, Lesquin, France; ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium.
| | - Anna Aimar
- ULB Brussels Free University-Ecole Polytechnique de Bruxelles, Beams (Bio, Electro And Mechanical Systems) Dept., Avenue Franklin Roosevelt No 50, Brussels, Belgium
| | - Luc Van Overstraeten
- ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium; HFSU rue Pierre Caille No 9, 7500 Tournai, Belgium
| | - Frédéric Schuind
- ULB Brussels Free University, Erasme Hospital, Lennik road No 808, Brussels, Belgium
| | - Bernardo Innocenti
- ULB Brussels Free University-Ecole Polytechnique de Bruxelles, Beams (Bio, Electro And Mechanical Systems) Dept., Avenue Franklin Roosevelt No 50, Brussels, Belgium
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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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Abstract
Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.
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Affiliation(s)
- Dana Rioux-Forker
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Yıldırım AM, Piskin A, Karaismailoglu B, Sener M. Functional and radiological results of partial capitate shortening osteotomy in the treatment of Kienböck's disease. J Hand Surg Eur Vol 2020; 45:403-407. [PMID: 32102583 DOI: 10.1177/1753193420905991] [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] [Indexed: 02/03/2023]
Abstract
This study assessed the functional and radiological results of partial capitate shortening osteotomy in the treatment of Lichtman stage 2 and 3A Kienböck's disease. Nineteen patients who underwent partial capitate shortening osteotomy between 2014 and 2017 were included. Functional and radiological parameters were assessed both pre- and postoperatively. The mean age was 35 years and the mean follow-up was 16 months. Pain scores, wrist range of motion, hand and finger strength, carpal height ratio and lunate height were significantly improved compared with their preoperative values. Sixteen patients were able to return to work. Ten of them had complete and six had partial revascularization. The mean time taken to return to work was 62 days. No vascularity was achieved in three patients who were unable to return to work. Partial capitate shortening osteotomy is effective in the treatment of stage 2 and 3A Kienböck's disease with successful results both functionally and radiologically. Level of evidence: IV.
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Affiliation(s)
| | - Ahmet Piskin
- Orthopaedics and Traumatology Department, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Muhittin Sener
- Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
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Arimitsu S, Shimada K, Moritomo H. Lunate fracture healing after partial capitate shortening in Kienböck disease. J Orthop Sci 2020; 25:428-434. [PMID: 31279495 DOI: 10.1016/j.jos.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unclear whether lunate fracture types in Kienböck disease correlate with the degree of fracture healing. This study aimed to review the clinical results of stage 3 Kienböck disease treated using partial capitate shortening (PCS) and to evaluate the healing rates of lunate fractures based on the fracture types. METHODS Twenty-three patients were clinically and radiographically followed up for >2 years after PCS. The preoperative location and postoperative healing of the lunate fracture were evaluated using plain radiography, computed tomography, and/or magnetic resonance imaging. Results were evaluated using the Kienböck scoring system by Nakamura. RESULTS PCS was clinically effective, demonstrating excellent and good results in 11 and 11 patients, respectively. Pain evaluated using the visual analog scale, wrist extension, flexion motion, and grip strength significantly improved postoperatively (p < 0.01). Fractures were preoperatively detected in all 23 cases. Fracture locations were preoperatively classified into five subtypes based on radiographs: volar pole in five patients, dorsal pole in three, coronal in five, transverse in nine, and ulnar in one. The overall union rate of the lunate fracture was 48%, whereas none of the coronal fractures healed. CONCLUSIONS PCS was effective in treating stage 3 Kienböck disease. Coronal lunate fractures had a poor healing rate relative to those of the other fracture types. STUDY DESIGN Clinical, retrospective study.
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Affiliation(s)
- Sayuri Arimitsu
- Yukioka Hospital Hand Center, 2-2-3 Ukita, Kita-ku, Osaka-shi, Osaka, 530-0021, Japan.
| | - Kozo Shimada
- Japan Community Health Care Organization Osaka Hospital, Department of Orthopaedic Surgery, 4-2-78, Fukushima, Fukushima-ku, Osaka-shi, Oksaka, 553-0003, Japan
| | - Hisao Moritomo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, 2-2-3, Ukita, Kita-ku, Osaka-shi, Osaka, 530-0021, Japan.
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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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A Comparative Study Between 2 Intracarpal Partial Shortening Osteotomy Techniques for Type II Lunate Kienbock Disease. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000319] [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: 11/26/2022]
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Camus EJ, Van Overstraeten L. Evaluation of Kienböck's Disease Treated by Camembert Osteotomy at Seven Years. J Wrist Surg 2019; 8:226-233. [PMID: 31192045 PMCID: PMC6546589 DOI: 10.1055/s-0039-1683931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
In Kienböck's disease, radius shortening osteotomy is the most common treatment. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical symptoms and limits lunate collapse. The series include 10 patients who underwent a Camembert osteotomy for Kienböck's disease between 2002 and 2012 (one bilaterally). They are six men and four women, aged 40.6 years. Five patients had an additional ulnar shortening osteotomy if ulnar variance was neutral or positive. The mean follow-up is 7 years. Preoperatively, range of motion, grip strength, pain, and functional scores were poor. All osteotomies healed within 3 months. Extension, ulnar deviation, grip, functional scores improved significantly. In 10 cases, there were improvement in the T1 and T2 signals on the magnetic resonance imaging (MRI). There was no lunate collapse. This series shows good results with no worsening of the lunate shape. There was no ulnocarpal impingement. The Camembert osteotomy proposes to offload the lunate and redirect strains toward the scaphoid. The supposed interest is to protect the lunate from collapse. In this small series, the Camembert osteotomy improved function in patients with early stage Kienböck's disease. MRI aspects improve in most cases and no patients collapsed. Camembert can be used in combination with a Sennwald's ulnar shortening when ulnar variance is neutral or positive. Authors propose this procedure for Lichtman's stages 1-2-3A if there are no cartilage or ligament lesions. This is a Level IV, case series study.
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Affiliation(s)
- Emmanuel J. Camus
- SELARL Chirurgie de la Main, Clinique Du Val de Sambre, Maubeuge, France
- ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Luc Van Overstraeten
- ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
- Hand Foot Surgery Unit, Tournai, Belgium
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Hegazy G, Akar A, Abd-Elghany T, Zayed E, Shaheen E, Mansour T. Treatment of Kienböck's Disease With Neutral Ulnar Variance by Distal Capitate Shortening and Arthrodesis to the Base of the Third Metacarpal Bone. J Hand Surg Am 2019; 44:518.e1-518.e9. [PMID: 30309665 DOI: 10.1016/j.jhsa.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/09/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated whether a surgical technique combining distal capitate shortening and arthrodesis to the base of the third metacarpal bone for the treatment of the early stages (stages II and IIIA) of Kienböck's disease with neutral ulnar variance resulted in pain relief, improvement in wrist motion, or changes in the radiographic evaluation. METHODS This retrospective study reviewed 22 patients with early stages of Kienböck's disease with neutral ulnar variance, treated by distal capitate shortening and arthrodesis to the base of the third metacarpal bone. Patients were divided into 2 groups by disease stage: stage II (n = 12) and stage IIIA (n = 10). There were 8 women and 14 men, with an average age of 35.7 years. The following parameters were measured before and after surgery: visual analog scale (VAS) for pain evaluation, grip strength, range of motion (ROM), ulnar variance, carpal height index, lunate height index, and the scapholunate and scaphocapitate angles. The patients were evaluated in accordance with Modified Mayo Wrist Score (MMWS). RESULTS The average follow-up period was 30.5 months (range, 26-36 months). The stage II group showed significant improvements in the mean VAS (58-5), ROM (57% to 73%), grip strength (54% to 75%), and MMWS (51-78). Patients in the stage IIIA group showed nonsignificant changes in mean VAS score (64-42.5), ROM (52.5% to 55.5%), grip strength (46.5% to 57.5%), and MMWS (36-50.5). Significant decreases in the carpal height index and scaphocapitate angle, and an increase in scapholunate angle in all stage IIIA patients were observed. CONCLUSIONS Distal capitate shortening with capitometacarpal arthrodesis can alleviate pain and improve ROM and grip strength in patients with stage II Kienböck's disease, but not in those with stage IIIA. Moreover, it cannot prevent carpal collapse, especially in stage IIIA of the disease. We do not recommend this technique for treating stage IIIA patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Galal Hegazy
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
| | - Ahmed Akar
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Tharwat Abd-Elghany
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Emad Zayed
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Elsayed Shaheen
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Tarek Mansour
- Radio-diagnosis Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt
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Tahta M, Zengin EC, Ozturk T, Mete BD, Gunal İ, Sener M. Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: Mid-Term Results. Plast Surg (Oakv) 2019; 27:141-146. [PMID: 31106172 DOI: 10.1177/2292550319828787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known. Objectives The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease. Methods Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations. Results The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients. Conclusions Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.
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Affiliation(s)
- Mesut Tahta
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Eyup C Zengin
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Tahir Ozturk
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - B Dirim Mete
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | | | - Muhittin Sener
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
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Hernández J, Pascual M, Gómez J. Osteotomía de acortamiento del hueso grande en la enfermedad de Kienböck asociada a varianza ulnar positiva o neutra. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2017. [DOI: 10.1016/j.ricma.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objetivos: La enfermedad de Kienböck se asocia generalmente a cubitus minus y la descompresión quirúrgica más común es a nivel radial. El objetivo es conocer los efectos de realizarla en el hueso grande cuando se encuentra asociada a varianza cubital normal o positiva.Material y métodos: Realizamos un estudio retrospectivo de los resultados de la osteotomía de acortamiento del hueso grande en la enfermedad de Kienböck sin cubitus minus. Hemos revisado a 6 pacientes, intervenidos entre 2006 y 2013 en el Hospital Universitario Ramón y Cajal (Madrid). El seguimiento medio fue 36 meses (12-93). Se registraron: escala de valoración del dolor (EVA), rango de movimiento de la muñeca, fuerza de prensión palmary de la pinza, valoración funcional (DASH, Mayo Score), así como estudio radiológico y con RM.Resultados: Se obtuvo una mejoría clínica y funcional de los parámetros estudiados, pero no de los radiológicos. En un caso la enfermedad evolucionó y el resto mantuvo los estadios radiológico (Lichtman) iniciales, consiguiendo la consolidación de la osteotomía en todos los casos. No se apreciaron complicaciones destacables.Conclusión: La osteotomía de acortamiento del hueso grande es una técnica que oferta buenos y duraderos resultados en pacientes con enfermedad de Kienböck sin cubitus minus ni cambios degenerativos carpianos.
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16
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Early results of partial capitate shortening osteotomy in management of Kienböck disease. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakagawa M, Omokawa S, Kira T, Kawamura K, Tanaka Y. Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease. J Wrist Surg 2016; 5:98-104. [PMID: 27104073 PMCID: PMC4838470 DOI: 10.1055/s-0036-1582427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
Purpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients. Average age was 32 years, and radiological grading according to Lichtman classification was stage 2 in 8 patients, stage 3A in 10 patients, and stage 3B in 10 patients. Temporary pinning fixing the midcarpal joint was conducted for 10 weeks postoperatively. Results Follow-up periods averaged 70 months. Pain reduced in 27 patients, and visual analog scale for pain of pre- and postoperative level averaged 59 and 18. Range of wrist flexion and extension motion improved from 87 to 117 degrees, and average grip strength improved from 21 kg preoperatively to 33 kg postoperatively. Carpal height ratio had almost no change from 0.52 to 0.53. Fragmentation of necrotic bone healed in 7 of the 14 cases. Comparative analyses of functional and radiological outcomes between three donor sites found no significant difference. Conclusion Three different vascularized bone grafts from the dorsal wrist and hand area demonstrated favorable and comparable functional outcomes. It was technically important to elevate vascular bundle with surrounding retinaculum or fascia, to include sufficient periosteum, and to insert the vascularized bone as the cortex aligned longitudinally.
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Affiliation(s)
- Makoto Nakagawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Tsutomu Kira
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara Prefecture, Japan
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Citlak A, Akgun U, Bulut T, Tahta M, Dirim Mete B, Sener M. Partial capitate shortening for Kienböck's disease. J Hand Surg Eur Vol 2015; 40:957-60. [PMID: 25432157 DOI: 10.1177/1753193414562355] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/22/2014] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to report our experience of partial capitate shortening in seven patients with a median 38 months follow-up. Staging was made by the Lichtman classification system and stage II and III-A patients were included in the study. The mean age was 34 years (range 22-52). Patients were assessed for pain, range of motion, grip and pinch strength, and satisfaction was recorded using a scale between 0 and 4. All these parameters showed improvement after surgery. The Lichtman stage, lunate height index and carpal height index were determined radiographically. Magnetic resonance images of the wrist were studied for lunate revascularization at the final follow-up and occurred in all patients. According to our study, partial capitate shortening seems an effective treatment for Lichtman stage II and III-A patients.Level IV case series study.
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Affiliation(s)
- A Citlak
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir, Turkey
| | - U Akgun
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir, Turkey
| | - T Bulut
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir, Turkey
| | - M Tahta
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir, Turkey
| | - B Dirim Mete
- Department of Radiology, Katip Celebi University, Izmir, Turkey
| | - M Sener
- Department of Orthopaedics and Traumatology, Katip Celebi University, Izmir, Turkey
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Kawanishi Y, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H. In vivo 3-dimensional analysis of stage III Kienböck disease: pattern of carpal deformity and radioscaphoid joint congruity. J Hand Surg Am 2015; 40:74-80. [PMID: 25534837 DOI: 10.1016/j.jhsa.2014.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/18/2014] [Accepted: 10/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine 3-dimensional carpal alignment and radioscaphoid joint (RSJ) congruity among normal wrists and those with Lichtman stage III Kienböck disease or scapholunate dislocation (SLD). METHODS We conducted 3-dimensional analysis based on computed tomographic data to compare 10 wrists of stage III Kienböck disease (5 IIIa and 5 IIIb) with 5 normal wrists and 3 wrists with SLD. A markerless bone registration technique was used to investigate the 3-dimensional position of the scaphoid relative to the radius. To evaluate RSJ congruency, the inferred contact area between the scaphoid proximal pole and the distal radius was calculated from 3-dimensional bone models. RESULTS The scaphoid position was not significantly different from normal wrists in stage IIIa Kienböck disease. Stage IIIb Kienböck disease was meaningfully associated with a flexed scaphoid and proximal translation of the centroid, but not dorsal translation of the scaphoid proximal pole, where RSJ congruity was preserved. With SLD, the scaphoid flexed to the same extent as that in stage IIIb Kienböck disease, and the proximal pole translated dorsally together with the capitate, producing RSJ incongruity. CONCLUSIONS The patterns of carpal collapse differed between stage IIIb Kienböck disease and SLD in terms of RSJ congruity. Our study showed that stage IIIb Kienböck disease did not involve dorsal subluxation of the scaphoid proximal pole and that RSJ congruity was retained, unlike SLD. CLINICAL RELEVANCE Our results suggest that carpal collapse in Kienböck disease is not associated with RSJ incongruity, which may explain why there are asymptomatic patients with Kienböck disease and carpal collapse.
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Affiliation(s)
- Yohei Kawanishi
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Hisao Moritomo
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan.
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Kazuomi Sugamoto
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan
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20
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Wollstein R, Wollstein A, Rodgers J, Ogden TJ. A hand therapy protocol for the treatment of lunate overload or early Kienbock's disease. J Hand Ther 2014; 26:255-59; quiz 260. [PMID: 23465629 DOI: 10.1016/j.jht.2012.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 12/20/2012] [Accepted: 12/25/2012] [Indexed: 02/03/2023]
Abstract
We describe a hand therapy protocol aimed at unloading the wrist and increasing blood supply to the wrist, specifically to the lunate. The protocol was used in a series of patients with clinical radial wrist pain, dysfunction and changes on wrist imaging studies. The patients were not candidates for surgical treatment. Application of the therapy protocol improved objective and subjective parameters such as pain and motion, and may provide a viable treatment option for patients with lunate overload or early Kienbock's disease that are not candidates for surgery.
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Affiliation(s)
- Ronit Wollstein
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Wollstein A, Tantawi D, Wollstein R. Bilateral Kienbock's disease concomitant with bilateral Legg-Calvé-Perthes disease: a case report. Hand (N Y) 2013; 8:120-2. [PMID: 24426907 PMCID: PMC3574489 DOI: 10.1007/s11552-012-9465-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Adi Wollstein
- Department of Orthopedic Surgery and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA 15261 USA
| | - Diya Tantawi
- Department of Orthopedic Surgery and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA 15261 USA
| | - Ronit Wollstein
- Department of Orthopedic Surgery and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, 3550 Terrace St, Pittsburgh, PA 15261 USA
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Kataoka T, Moritomo H, Omokawa S, Iida A, Wada T, Aoki M. DECOMPRESSION EFFECT OF PARTIAL CAPITATE SHORTENING FOR KIENBOCK'S DISEASE: A BIOMECHANICAL STUDY. ACTA ACUST UNITED AC 2012; 17:299-305. [DOI: 10.1142/s0218810412500219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although capitate shortening for Kienbock's disease decompresses the radiolunate joint, the distal carpal row migrates proximally postoperatively and the carpal alignment subsequently collapses. We hypothesised that partial capitate shortening, in which only the lunate facet of the capitate is shortened and the scaphocapitate joint is preserved, could achieve adequate decompression without carpal collapse. Using 11 cadavers, we measured the intra-articular pressure with an axial load on the radioscaphoid, radiolunate and ulnocarpal joints before and after resection. We also investigated whether the decompression effect is related to the presence of the lunohamate articulation. After resection, the radioscaphoid joint mean pressure was significantly increased by an average of 39%, the radiolunate joint mean pressure was significantly decreased by an average of 53% and the ulnocarpal joint mean pressure was unchanged. The radiolunate joint mean pressure significantly decreased irrespective of the lunohamate articulation status.
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Affiliation(s)
- Toshiyuki Kataoka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka 567-0801, Japan
| | - Shohei Omokawa
- Department of Orthopedic Surgery, Nara Medical University, Nara 634-8522, Japan
| | - Akio Iida
- Department of Orthopedic Surgery, Hanna Central Hospital, Nara 630-0243, Japan
| | - Takuro Wada
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
| | - Mitsuhiro Aoki
- Department of Orthopedic Surgery, Sapporo Daiichi Hospital, Sapporo 063-0804, Japan
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23
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Afshar A. Lunate revascularization after capitate shortening osteotomy in Kienböck's disease. J Hand Surg Am 2010; 35:1943-6. [PMID: 21115303 DOI: 10.1016/j.jhsa.2010.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of surgical treatment in the early stages of Kienböck's disease is to decrease compressive loading of the lunate to promote revascularization. Capitate shortening osteotomy is one technique that has been advocated in Kienböck's disease with ulnar neutral or positive variance and Lichtman stage I to IIIA. The purpose of this study was to examine the revascularization process of the lunate after capitate shortening osteotomy. METHODS This was a retrospective study of 9 patients with Kienböck's disease with Lichtman stage II or IIIA and ulnar neutral or positive variance. I confirmed avascular necrosis of the lunate in all the patients by magnetic resonance imaging preoperatively. Capitate shortening osteotomy was performed through a dorsal approach and fixed with K-wires. I used magnetic resonance images with fat suppression to detect the revascularization of the lunate after surgery. RESULTS The mean follow-up was 12 months (range, 8-16 mo). All patients demonstrated partial revascularization of the lunate and the mean revascularization time was 4.7 months (range, 3-7 mo), which was interpreted as the beginning of the revascularization process. CONCLUSIONS Capitate shortening osteotomy is an efficient technique to induce the revascularization process in the early stages of Kienböck's disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran.
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Rabarin F, Saint Cast Y, Cesari B, Raimbeau G, Fouque PA. L’ostéotomie du capitatum dans la maladie de Kienböck. Résultats cliniques et radiologiques à cinq ans de recul moyen. À propos de 12 cas. ACTA ACUST UNITED AC 2010; 29:67-71. [DOI: 10.1016/j.main.2010.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 01/02/2010] [Accepted: 02/01/2010] [Indexed: 12/01/2022]
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