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Hegazy G, Fouaad AA, El-Sadek RE, Zayed E, Saqr Y, Alshal E. Scaphocapitate arthrodesis with lunate preservation for Kienböck's disease: prospective outcomes study. Arch Orthop Trauma Surg 2024; 144:3875-3884. [PMID: 39008072 PMCID: PMC11417059 DOI: 10.1007/s00402-024-05423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck's disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck's disease. METHODS Thirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck's disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed. RESULTS For all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively. CONCLUSION Evidence level: II. Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck's disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck's disease.
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Affiliation(s)
- Galal Hegazy
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt.
| | - Amro A Fouaad
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt
| | - Rashed Emam El-Sadek
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt
| | - Emad Zayed
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt
| | - Yasser Saqr
- Orthopedic Department, Faculty of Medicine, Portsaid University, Portfouad, Portsaid, 42526, Egypt
| | - Ehab Alshal
- Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut City, Assiut, 71524, Egypt
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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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Jaiswal AM, Shrivastava S, Dhanwani Y, Chandanwale R, Bhakaney PR. Managing Kienbock Disease's Surgical Treatment and Outcome Analysis: A Case Report and Review of Literature. Cureus 2024; 16:e63352. [PMID: 39070500 PMCID: PMC11283645 DOI: 10.7759/cureus.63352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
A 38-year-old man without a severe traumatic history reported to the outpatient department (OPD) with wrist pain at the dorsal aspect, mild swelling, stiffness, and restricted mobility at the left wrist joint. The patient had been experiencing these symptoms for a year. There was sharp tenderness, graded as 4 above the lunate bone, on examination of the left wrist joint. Advanced imaging, which is magnetic resonance imaging (MRI), and radiographs suggested that the patient had Kienbock's illness. Typically, the surgical approach for Kienbock's used is wrist fusion or proximal row carpectomy. However, in this case, a novel strategy of bone grafting, scaphoid-capitate fusion, and lunate excision was adopted. This case report explains the outcome of our scaphoid-capitate arthrodesis, which was done to maintain functional mobility and relieve discomfort by halting the progression of carpal collapse and carpal-ulnar translation.
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Affiliation(s)
- Ankit M Jaiswal
- Orthopedic Surgery, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopedic Surgery, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yash Dhanwani
- Orthopedic Surgery, Government Medical College and Hospital, Akola, Akola, IND
| | - Rohan Chandanwale
- Orthopedic Surgery, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Koh IH, Kim HS, Kim SH, Oh WT, Suk YJ, Choi YR. Examining the Efficacy of Arthroscopic Scaphocapitate Arthrodesis for Advanced Kienbock's Disease: Clinical and Radiological Outcomes. Clin Orthop Surg 2024; 16:448-454. [PMID: 38827751 PMCID: PMC11130623 DOI: 10.4055/cios23167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/23/2023] [Accepted: 01/01/2024] [Indexed: 06/04/2024] Open
Abstract
Background Altering wrist biomechanics, Kienbock's disease leads to progressive carpal collapse that results in early arthritis and degenerative changes. By shifting the loading axis toward the radioscaphoid joint, scaphocapitate arthrodesis (SCA) has been reported as a salvage procedure effective in treating symptomatic patients with advanced Kienbock's disease. In this study, we aimed to evaluate the clinical and radiological outcomes of arthroscopic SCA in symptomatic patients with advanced stages of Kienbock's disease. Methods Between March 2010 and February 2021, we included 15 patients with symptomatic stage IIIA (n=2) and stage IIIB (n=13) Kienbock's disease who were followed up for a minimum of 24 months after arthroscopic SCA with or without lunate excision. The lunate was excised in 6 patients and retained in 9. Visual analog scale (VAS) pain score, grip strength, range of motion (ROM), active flexion-extension arc, and modified Mayo wrist score (MMWS) were measured preoperatively and at each follow-up examination after surgery. Operation-related complications and radiographic changes were also assessed. Results There were 13 women and 2 men, with a mean age of 57.6 years (range, 21-74 years) at the time of undergoing arthroscopic SCA. Follow-up ranged from 24 to 116 months, with an average of 56.9 ± 32.3 months. Bony union was achieved in all patients. At preoperative examination, wrist ROM (67%) and grip strength (48%) significantly decreased, compared to the contralateral wrist. At the final follow-up, there were significant improvements in VAS, grip strength, and MMWS, whereas the active wrist ROM showed no significant change. Radioscaphoid angle recovered after surgery, while radiographic carpal collapse and ulnar translation of the carpus occurred. In subgroup analysis according to excision of the lunate, there were no significant differences in VAS, MMWS, grip strength, or total ROM. However, increased ulnar translation and decreased radial deviation were noted in the lunate excision group. Conclusions Arthroscopic SCA achieved significant improvements in pain and wrist function in patients with advanced Kienbock's disease without any complications. Excision of the lunate when performing arthroscopic SCA seemed to induce progressive carpal ulnar translation, with no apparent clinical benefits over retaining it.
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Affiliation(s)
- Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Orthopaedic Surgery, St. Peter’s Hospital, Seoul, Korea
| | - Sang-Hee Kim
- Department of Orthopaedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Jun Suk
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Henry M, Lundy FH, Henry GK. Long-term Outcomes for Late-Phase Kienböck's Tenoarthroplasty. Hand (N Y) 2024; 19:594-597. [PMID: 36495021 PMCID: PMC11141407 DOI: 10.1177/15589447221136622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In late Kienbӧck's, the lunate is fully fragmented and nonreconstructible. Replacing the lunate with a pyrocarbon prosthesis preserves load distribution and avoids carpectomy or fusion, but leaves the wrist intrinsically unstable, requiring additional soft-tissue stabilization techniques. METHODS Five men and 7 women with a mean age of 43 (±15) years underwent prosthetic replacement of the lunate with dual bundle scaphoid-triquetrum tenodesis for carpal stabilization. The mean follow-up interval from initial surgery was 9.1 (±1.7) years. Outcomes were Disabilities of Arm, Shoulder, and Hand (DASH) score, revision or conversion surgery, and wrist range of motion. RESULTS The mean DASH score was 8.9 (±7.1). No patients reported any additional revision or conversion surgery. The mean wrist flexion was 60° (±14°); wrist extension was 45° (±21°). CONCLUSIONS Clinical outcomes proved more favorable than anticipated, particularly the self-rated outcomes scores and the absence of any revision or conversion surgery.
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Xiang F, Fan W, Tan X, Liu J, Gu H, Yang Y. A novel capitate bone Ilizarov external fixator for treating Kienböck's disease: an anatomical and biomechanical study. Sci Rep 2024; 14:7111. [PMID: 38531907 DOI: 10.1038/s41598-024-55445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
This study aims to measure anatomical data of the capitate bone, develop an external fixator for treating late-stage osteonecrosis of lunate through Ilizarov technique, and evaluate its biomechanical performance. We selected eight wrist joint specimens to measure various parameters of the capitate bone, including its length, the distance from the junction of capitate head and body to the proximal end, as well as the width of its proximal head and distal body. Additionally, we measured these same indicators in 107 patients who had undergone wrist X-ray examination. Based on our measurements, we categorized the capitate bone into two groups and designed two types of capitate bone Ilizarov external fixator (CIEF) for it. Then, we compared it with the orthofix external fixator (OEF) through dynamic fatigue biomechanical experiments and pull-out resistance experiments. The results of the measurement revealed two categories of general patterns in the capitate bone. The first type maintains a consistent longitudinal axis between the proximal and distal ends. The second type is characterized by its proximal end being close to the radial side and its distal end being close to the ulnar side. In the dynamic tensile fatigue test, CIEF-A and CIEF-B had smaller maximum displacement values compared to the OEF (P < 0.05). In the anti-pull-out experiment, both CIEF-A and CIEF-B exhibited higher maximum pull-out force than the OEF (P < 0.05). CIFE is a treatment for advanced osteonecrosis of the lunate bone. It is specifically designed to align with the anatomical characteristics of the capitate bone, providing excellent biomechanical properties and a simple clinical procedure. However, additional clinical experiments are needed to confirm its effectiveness in the future.
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Affiliation(s)
- Feifan Xiang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No 25 Tai Ping Street, Jiang Yang District, Luzhou, 646000, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
| | - Wei Fan
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No 25 Tai Ping Street, Jiang Yang District, Luzhou, 646000, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
| | - Xiaoqi Tan
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Jinhui Liu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No 25 Tai Ping Street, Jiang Yang District, Luzhou, 646000, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China
| | - Hao Gu
- Department of Orthopedics, Baoji Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shanxi, China.
| | - Yunkang Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No 25 Tai Ping Street, Jiang Yang District, Luzhou, 646000, Sichuan, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, China.
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Bouri F, Hantouly AT, Alzobi O, Toubasi AA, Kayali H, Fuad M, Muneer M, Hagert E, Ibrahim A. Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:435-444. [PMID: 37521555 PMCID: PMC10382890 DOI: 10.1016/j.jhsg.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.
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Affiliation(s)
- Fadi Bouri
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mazhar Fuad
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Muneer
- Department of Plastic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden
| | - Ayman Ibrahim
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Shams A, Samy MA, Mesregah MK, Abosalem AA. Scapho-luno-capitate fusion with proximal lunate articular surface preservation for management of grade IIIA Kienböck's disease: a prospective case series. J Orthop Traumatol 2023; 24:23. [PMID: 37199858 DOI: 10.1186/s10195-023-00703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Kienböck's disease is idiopathic lunate avascular necrosis, which may lead to lunate collapse, abnormal carpal motion and wrist arthritis. The current study aimed to assess the outcomes of treating stage IIIA Kienböck's disease by a novel technique of limited carpal fusion via partial lunate excision with preservation of the proximal lunate surface and scapho-luno-capitate (SLC) fusion. MATERIALS AND METHODS We conducted a prospective study of patients with grade IIIA Kienböck's disease managed with a novel technique of limited carpal fusion comprising SLC fusion with preservation of the proximal lunate articular cartilage. Autologous iliac crest bone grafting and K-wires fixation were used to enhance the osteosynthesis of the SLC fusion. The minimum follow-up period was 1 year. A visual analog scale (VAS) and the Mayo Wrist Score were utilized for the evaluation of patient residual pain and functional assessment, respectively. A digital Smedley dynamometer was used to measure the grip strength. The modified carpal height ratio (MCHR) was used for monitoring carpal collapse. The radioscaphoid angle, scapholunate angle, and the modified carpal-ulnar distance ratio were used for the assessment of carpal bones alignment and ulnar translocation of carpal bones. RESULTS This study included 20 patients with a mean age of 27.9 ± 5.5 years. At the last follow-up, the mean range of flexion/extension range of motion (% of normal side) improved from 52.8 ± 5.4% to 65.7 ± 11.1%, P = 0.002, the mean grip strength (% of normal side) improved from 54.6 ± 11.8% to 88.3 ± 12.4%, P = 0.001, the mean Mayo Wrist Score improved from 41.5 ± 8.2 to 81 ± 9.2, P = 0.002, and the mean VAS score reduced from 6.1 ± 1.6 to 0.6 ± 0.4, P = 0.004. The mean follow-up MCHR improved from 1.46 ± 0.11 to 1.59 ± 0.34, P = 0.112. The mean radioscaphoid angle improved from 63 ± 10º to 49 ± 6º, P = 0.011. The mean scapholunate angle increased from 32 ± 6º to 47 ± 8º, P = 0.004. The mean modified carpal-ulnar distance ratio was preserved and none of the patients developed ulnar translocation of the carpal bones. Radiological union was achieved in all patients. CONCLUSIONS Scapho-luno-capitate fusion with partial lunate excision and preservation of the proximal lunate surface is a valuable option for treating stage IIIA Kienböck's disease, with satisfactory outcomes. Level of evidence Level IV. Trial registration Not applicable.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Ahmed Samy
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| | - Ahmed Abdelazim Abosalem
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, 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 2023; 15:87-97. [PMID: 37020608 PMCID: PMC10070007 DOI: 10.1055/s-0041-1730888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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
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10
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Catapano J, Higgins JP. An Algorithmic Approach to the Treatment of Kienböck Disease. Hand Clin 2022; 38:417-424. [PMID: 36244709 DOI: 10.1016/j.hcl.2022.03.005] [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
The algorithm and rationale described is a reflection of our own surgical experience for this challenging disorder and can be compared with other publications. Our algorithm has evolved from treatment of a large volume of patients with Kienböck disease in a referral practice. However, it is limited to the management that we have found logical, effective, and within our scope of experience. The treatment guidelines for our specialty as a whole will evolve as our understanding of the etiology and our ability to quantify efficacy improves.
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Affiliation(s)
- Joseph Catapano
- Division of Plastic and Reconstructive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly Wing, Room 4-072, Toronto, ON M5B 1W8, Canada
| | - James P Higgins
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, JPB #200, Baltimore, MD 21218, USA.
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11
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Meena A, Shaina S, Saikia SS, Raj A A, Verma N, Attri M. Management of type 3 Kienbock's disease in manual workers by scaphocapitate fusion with minimum 7-year follow-up. J Clin Orthop Trauma 2022; 28:101854. [PMID: 35433251 PMCID: PMC9006633 DOI: 10.1016/j.jcot.2022.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/05/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Kienbock's disease results in altered wrist biomechanics producing debilitating pain at the wrist. The disease is staged according to radiological and clinical findings and the stage guides the treatment. Various treatment options have been described for stage 3, however, there is a lack of consensus over these treatment methods. Scaphocapitate fusion is the preferred surgical option for advanced Kienbock's disease. Previous studies had heterogeneous cohorts with a short duration of follow-up and a lack of uniform surgical technique. The purpose of the study was to show the long-term functional and radiological outcome of scaphocapitate arthrodesis (SCA) by using Herbert screw for the treatment of Kienbock's disease in manual workers. METHODS For this single-centre, retrospective study, all consecutive patients who were manual workers and managed by SCA between January 2010 and Jan 2014 for Lichtman stage IIIA and IIIB with at least 7 years of follow-up were included. Patients were assessed using clinical and radiological parameters preoperatively and in the follow-up period. Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Related Wrist Evaluation (PRWE), and VAS for pain were assessed. RESULTS Out of 27 patients, 4 lost to follow-up, therefore, 23 patients (14 women and 9 men) with 30 years of median age at the time of the surgery were included. DASH scores, PRWE scores, and VAS for pain significantly improved (p < 0.5) after surgery. Wrist range of motion and grip strength also improved significantly (p < 0.5). Postoperative radiological parameters were found to be within a normal range. CONCLUSION Scaphocapitate fusion by Herbert screws gives good functional, clinical, and radiological outcomes, in stage 3 of Kienbock's disease with excellent rates of fusion with low complications. Even, in manual workers, scaphocapitate fusion can reliably provide good outcomes and this is maintained in the mid to long-term follow-up. Therefore, it should be considered as one of the procedures of choice. LEVEL OF EVIDENCE Retrospective, Level 4.
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12
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Wren ER, Tsai TM. A case of scaphocapitate arthrodesis for a failed lunate prosthesis in kienbock disease – 35 year follow up. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2022; 9:105-109. [PMID: 35402657 PMCID: PMC8986283 DOI: 10.1080/23320885.2022.2054813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We report on the clinical history of a young male laborer with Lichtman Stage II Kienbock disease, who underwent a scaphocapitate arthrodesis after a failed silicone lunate prosthesis. After 35 years of follow-up, no further surgical intervention has been warranted despite progression of radiocarpal and ulnocarpal arthritis.
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Affiliation(s)
- Ethan R. Wren
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Tsu-Min Tsai
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
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13
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Wang PQ, Charron BP, Chan KTK, Grewal R, Suh N. Potential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review. Hand (N Y) 2022; 18:6S-16S. [PMID: 35043699 PMCID: PMC10052625 DOI: 10.1177/15589447211066613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this systematic review is to identify whether non-salvage procedures can provide satisfactory and acceptable outcomes in Lichtman stage IV disease. METHODS The MEDLINE, Embase, and Cochrane databases were systematically searched for English publications between 1989 and 2019 that reported stage IV-specific primary treatment outcomes. Revisions and skeletally immature patients were excluded. Data extracted were patient demographics, pain scores, range of motion (ROM), grip strength, and patient-reported outcome measures (PROMs). The results were pooled into 3 categories: conservative management, non-salvage, and salvage procedures. RESULTS Data from 24 studies (n = 114 patients) were extracted. Compared with conservative management and non-salvage treatment (joint-leveling radial osteotomies, lunate reconstruction), salvage procedures (intercarpal and radiocarpal arthrodesis, proximal row carpectomy, total wrist arthroplasty) showed significantly decreased ROM in flexion-extension arc of motion (89° vs 95° vs 73°, respectively, P = .0001) and no significant differences in grip strength as a percentage of the contralateral side (83% vs 86% vs 79%, respectively, P = .28). All reported treatments provided pain relief, ability to return to previous occupations, and variable PROMs. CONCLUSIONS In young, active, and labor-intensive patients, motion-preserving, non-salvage options may be worth trialing as they do not preclude future salvage options.
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Affiliation(s)
| | | | - Kevin T K Chan
- Spectrum Health/Michigan State University, Grand Rapids, USA
| | - Ruby Grewal
- Western University, London, ON, Canada.,St. Joseph's Health Care London, ON, Canada
| | - Nina Suh
- Western University, London, ON, Canada.,St. Joseph's Health Care London, ON, Canada
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14
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Teng XF, Yuan HZ, Chen H. Evaluation of the efficacy of wrist arthroscopic surgery for aseptic necrosis of lunate bone. Orthop Surg 2021; 14:486-491. [PMID: 34939331 PMCID: PMC8926995 DOI: 10.1111/os.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the use of wrist arthroscopy for treatment of aseptic necrosis of lunate bone and its curative effect. Methods From March 2012 to January 2016, 12 patients with aseptic necrosis of lunate bone underwent necrotic lunate bone extirpation assisted by wrist arthroscopy, and the scaphocapitate joint treated with fusion‐stabilization were selected. Among these patients, 10 patients were male and two patients were female. The age of these patients ranged from 25 to 42 years old, with an average age of 32 years old. These lesions were located in the right hand in eight patients, and in the left hand in four patients. Lichtman stage: stage IIIA in two patients, and stage IIIB in 10 patients. All patients were diagnosed by anterior lateral radiographs and magnetic resonance imaging (MRI). From the second day after the surgery, patients underwent active motion for the metacarpophalangeal joint and interphalangeal joints. When the X‐ray film indicated that the fracture had healed, patients began to resume their daily activities and work. After surgery, the plain films of all planes, including the axial plane of the scaphoid, were taken every month, until fracture healing. All patients were followed up for a mean duration of 8 months, and the Mayo wrist score was used to assess the range of motion of the wrist joint and grip force during the follow‐ups for objective function evaluation. Results Fracture healing was obtained in all patients within 9–12 weeks after the operation, and average healing time was 10 weeks. The duration of follow‐up ranged between 6–14 months, and the mean duration was 8 months. According to the modified Mayo wrist score, the objective function of the wrist joint was evaluated as follows: flexion and extension range of the wrist joint was 40°–110°, with an average of 105°, which was 80% of that of the unaffected side. Radioulnar deviation was 45°‐80°, with an average of 55°, which was 82% of that of the unaffected side. Grip force was 25–48 kg, with an average of 40 kg, which was 84% of that of the unaffected side. The modified Mayo wrist score was good in eight patients, acceptable in three patients, and poor in one patient. Conclusions Wrist arthroscopy is an effective and feasible tool for the treatment of aseptic necrosis of the lunate bone, and the right kind of surgical procedure should be selected for different stages of the disease, and wrist arthroscopy is applied timely, in order to achieve the desired therapeutic effect.
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Affiliation(s)
- Xiao-Feng Teng
- Department of Hand Surgery, Sixth Hospital of Ningbo, Zhejiang, China
| | - Hui-Zong Yuan
- Department of Hand Surgery, Sixth Hospital of Ningbo, Zhejiang, China
| | - Hong Chen
- Department of Hand Surgery, Sixth Hospital of Ningbo, Zhejiang, China
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15
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Park JH, Kang JW, Choi JS, Kim D, Choi IC, Park JW. Influence of carpal-ulnar translation on clinical outcome after scaphocapitate arthrodesis for the treatment of late-stage Kienböck disease. J Plast Reconstr Aesthet Surg 2021; 75:348-355. [PMID: 34666943 DOI: 10.1016/j.bjps.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study sought to compare postoperative outcomes after scaphocapitate arthrodesis (SCA) for the treatment of late-stage Kienböck disease according to the amount of ulnar translation of the carpus and to identify surgical factors associated with carpal-ulnar translation. METHODS Thirty-nine patients diagnosed with Kienböck disease (Lichtman stages III-IV) and treated with SCA were retrospectively reviewed. They were divided into the translated group (n=28) and untranslated group (n=11) according to the presence of carpal-ulnar translation. The following surgical factors in the patients were assessed: excision of the lunate, postoperative carpal height ratio, and radioscaphoid angle (RSA). Pain Visual Analog scale (VAS) score, wrist range of motion, grip strength, modified Mayo wrist score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and progression of radioscaphoid osteoarthritis were also assessed. RESULTS All patients showed functional improvement after a mean postoperative follow-up period of 40 months (VAS: 4.1 vs. 1.1, p <0.001; grip strength, 42.3 vs. 51.2 lb., p = 0.002; MMWS, 52.6 vs. 69.5, p <0.001; QuickDASH, 33.7 vs. 21.5, p <0.001). No statistically significant differences were found between the two groups in terms of outcome measures. Among the assessed surgical factors, the mean postoperative RSA was significantly smaller in the translated group than in the untranslated group (34.8° vs. 46.8°, p = 0.008). The proportion of patients with postoperative RSA <30° was significantly higher in the translated group than in the untranslated group (54.5% vs. 0%, p<0.001). CONCLUSION These results suggest that sufficient pain relief and functional improvement can be achieved after SCA for the treatment of late-stage Kienböck disease disregarding the occurrence of carpal-ulnar translation. In this study, overcorrection to RSA <30° induced more frequent carpal-ulnar translation after SCA.
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Affiliation(s)
- Ji Hun Park
- Department of Orthopedic Surgery, Korea University Medicine Guro Hospital, Seoul, South Korea.
| | - Jong Woo Kang
- Department of Orthopedic Surgery, Korea University Medicine Ansan Hospital, Ansan-si, Gyeonggido, South Korea.
| | - Jeong Seok Choi
- Department of Orthopedic Surgery, Korea University Medicine Guro Hospital, Seoul, South Korea
| | - Dongmin Kim
- Joint Center, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - In Cheul Choi
- Department of Orthopedic Surgery, Korea University Medicine Anam Hospital, Seoul, South Korea.
| | - Jong Woong Park
- Department of Orthopedic Surgery, Korea University Medicine Anam Hospital, Seoul, South Korea.
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16
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Biomechanical comparison of arthroscopic and open lunate excisions in the cadaveric wrist. Clin Biomech (Bristol, Avon) 2021; 84:105343. [PMID: 33836491 DOI: 10.1016/j.clinbiomech.2021.105343] [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: 12/09/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In advanced Kienböck disease, unreconstructible lunate should be excised as a salvage procedure. There is a lack of information about the biomechanical approaches evaluating the carpal kinematics after lunate excision. We hypothesized that arthroscopic lunate excision would not break the ring structure of the proximal carpal row, preventing carpal instability. We aimed to investigate changes in carpal kinematics following arthroscopic and open lunate excisions. METHODS We used upper extremities from five fresh cadavers and simulated arthroscopic and open lunate excisions. Arthroscopic lunate excision was performed to preserve the attachment sites of intrinsic and extrinsic carpal ligaments to the lunate. Open lunate excision was conducted with sectioning of the intrinsic and extrinsic carpal ligaments. Using a three-dimensional space electromagnetic tracking device, rotation angles of the scaphoid and triquetrum and the change of scaphotriquetrum distance were measured under axial loading. We compared the rotation angles and the change of scaphotriquetrum distance among intact wrists, open, and arthroscopic lunate excisions. FINDINGS No Significant differences in the rotation angle of the scaphoid and triquetrum or the change of scaphotriquetrum distance were found between intact wrist and arthroscopic lunate excision. The triquetrum significantly dorsiflexed and supinated in wrists with open lunate excisions compared with intact wrists. Significant differences in the change of scaphotriquetrum distance were found between intact and openly excised wrists and between arthroscopic and open excisions. INTERPRETATION Arthroscopic lunate excision potentially prevented kinematic change of the proximal carpal row under axial loading by maintaining the integrity of attachment sites of carpal ligaments.
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17
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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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18
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Combined vascularized bone graft and scaphocapitate fusion in the treatment of stage III(b) Kienböck’s disease: a cohort study involving 11 patients. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Collon S, Tham S, McCombe D, Bacle G. Scaphocapitate fusion for the treatment of Lichtman stage III Kienböck's disease. Results of a single center study with literature review. HAND SURGERY & REHABILITATION 2020; 39:201-206. [DOI: 10.1016/j.hansur.2020.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
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20
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Chou J, Bacle G, Ek ETH, Tham SKY. Fixation of the Fractured Lunate in Kienböck Disease. J Hand Surg Am 2019; 44:67.e1-67.e8. [PMID: 29934081 DOI: 10.1016/j.jhsa.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe an uncommon subset of fractured lunates in Kienböck disease that is salvageable by internal fixation. METHODS We performed a retrospective review for patients with Kienböck disease treated by internal fixation. Demographic data, objective and radiographic measurements, patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and pain (visual analog scale) scores were collected. RESULTS Of the 7 patients treated, 5 were available for review. At an average follow-up of 7.1 years (range, 1.5-15 years), all patients had activity-related wrist pain but were pain-free at rest. Radiographic assessment showed union in all lunates and a normal radioscaphoid angle and Stahl index. The modified carpal height ratio was reduced in 4 patients and normal in one. There was no observed narrowing or irregularity of the radiocarpal or midcarpal joints. Patient-reported outcome measures in 2 patients were unsatisfactory. CONCLUSIONS Computed tomography of the lunate in Kienböck disease is an important investigative tool. A coronal split fracture of these lunates can be salvageable by internal fixation. Revascularization of the lunate can be performed when the fragment is of sufficient size. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Justin Chou
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - Guillaume Bacle
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Melbourne Orthopaedic Group, Victoria, Australia
| | - Eugene T H Ek
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, Tours, France
| | - Stephen K Y Tham
- Victorian Hand Surgery Associates, St. Vincent's Hand Surgery Unit, Victoria, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia.
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21
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Matsumoto T, Kakinoki R, Ikeguchi R, Ohta S, Akagi M, Matsuda S. Vascularized Bone Graft to the Lunate Combined With Temporary Scaphocapitate Fixation for Treatment of Stage III Kienböck Disease: A Report of the Results, a Minimum of 2 Years After Surgery. J Hand Surg Am 2018; 43:773.e1-773.e7. [PMID: 29454599 DOI: 10.1016/j.jhsa.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 12/04/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To report the outcomes of patients with stage III Kienböck disease treated by vascularized bone graft (VBG) followed by temporary scaphocapitate (SC) fixation, a minimum of 2 years after surgery. METHODS Twenty-six patients (mean age, 35 years) with stage III Kienböck disease (16 with stage IIIA and 10 with stage IIIB), treated with VBG followed by SC fixation for 4 months, were retrospectively followed for at least 2 years (range, 24-121 months; mean, 61.8 months). The preoperative and postoperative assessments included range of motion (ROM) of the wrist, grip strength (GS), wrist pain, the modified Mayo wrist score (MMWS), carpal height ratio (CHR), Ståhl index (STI), and radioscaphoid angle (RSA). The outcomes of each assessment of the stages IIIA and IIIB groups at the final examination were compared with those before surgery. RESULTS In both stages IIIA and IIIB groups, GS increased after surgery. Decrease of CHR and STI was associated with the increase of RSA in the stage IIIA group after surgery, while RSA decreased, although neither CHR nor STI significantly increased in the stage IIIB patients. No patient demonstrated deterioration of the wrist pain after surgery. Twenty-one of 26 patients had an improved MMWS grade at the final follow-up. CONCLUSIONS Vascularized bone graft combined with SC fixation for 4 months provided greater GS, pain relief, and functional improvement compared with before surgery in both stages IIIA and IIIB groups. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Taiichi Matsumoto
- Department of Orthopedic Surgery, Kurashiki Central Hospital, Osaka, Japan
| | - Ryosuke Kakinoki
- Department of Orthopedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
| | - Ryosuke Ikeguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Ohta
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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22
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Charre A, Delclaux S, Apredoai C, Ayel JE, Rongieres M, Mansat P. Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up. J Hand Surg Eur Vol 2018; 43:362-368. [PMID: 29105588 DOI: 10.1177/1753193417739247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amaury Charre
- 1 Institut locomoteur University Hospital, Toulouse, France
| | | | | | | | | | - Pierre Mansat
- 1 Institut locomoteur University Hospital, Toulouse, France
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23
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Kalb K, van Schoonhoven J, Windolf J, Pillukat T. [Treatment of necrosis of the lunate bone]. Unfallchirurg 2018; 121:381-390. [PMID: 29549407 DOI: 10.1007/s00113-018-0477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There still is no standard therapy that predictably results in healing of avascular necrosis of the lunate bone. Nevertheless, there exists a wide spectrum of operative treatment options for different stages. OBJECTIVE This article reviews the treatment options for necrosis of the lunate bone and proposes algorithms based on the age of the patient and condition of the lunate bone and the wrist. METHODS Surgical treatment options for necrosis of the lunate bone can be divided into relieving or revascularization procedures and salvage procedures. RECOMMENDATIONS For patients under 20 years old the treatment of choice is prolonged immobilization, in cases of non-response or progression, minimally invasive and relieving procedures are used. In adult patients with limited affection of the lunate bone the first therapeutic approach should also be immobilization. If in progressive disease or advanced stages only the lunate bone is compromised but reconstructable, restoration should be considered. In progressive collapse of a non-reconstructable lunate bone the therapeutic efforts shift to mobility-preserving procedures utilizing still functional articulations of the wrist. If all functional articulations are lost only classical salvage procedures are feasible. CONCLUSION According to the presented algorithms a stage-dependent therapy of necrosis of the lunate bone is possible. It should not be ignored that there are still no scientific and evidence-based arguments for some of these treatment options. This is also true for maximally invasive procedures, where superiority to more simple procedures have not been proven. Therefore, their application should be restricted and based on an individual decision.
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Affiliation(s)
- K Kalb
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - T Pillukat
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
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Abstract
Kienbock disease (KD) is a disease of uncertain etiology, leading to chondral and osseous change in the lunate and wrist. Traditionally, Lichtman's classification of KD, based on radiographic appearances, has been used to direct treatment. Diagnostic wrist arthroscopy allows direct assessment of the lunate and surrounding articulations. Wrist arthroscopy can also serve as a therapeutic tool for performing debridement, resection, or arthrodesis procedures. The new Lichtman-Bain algorithm takes into consideration the status of the lunate, the effect on the wrist, and surgical and patient factors to guide management.
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Affiliation(s)
- Simon B M MacLean
- Department of Orthopaedic Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Karim Kantar
- Department of Orthopaedic Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David M Lichtman
- Uniformed Services University, Bethesda, MD, USA; Department of Orthopaedic Surgery, University of North Texas, Health Science Center, Fort Worth, TX, USA
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25
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Shin YH, Kim J, Gong HS, Rhee SH, Cho MJ, Baek GH. Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck's Disease. Clin Orthop Surg 2017; 9:355-362. [PMID: 28861204 PMCID: PMC5567032 DOI: 10.4055/cios.2017.9.3.355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/05/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radius osteotomies showed favorable clinical outcome in Kienböck's disease. However, few articles have been published on the long-term outcome of lateral wedge osteotomy of the radius in patients with advanced stage Kienböck's disease. METHODS Eleven patients with Lichtman stage IIIB/IV Kienböck's disease (group A; mean follow-up period, 86.1 months; range, 48 to 163 months) and 14 patients with Lichtman stage IIIA Kienböck's disease (group B; mean follow-up period, 85.1 months; range, 49 to 144 months) underwent radial wedge osteotomy between August 2004 and August 2012. Radiological changes of the lunate and radiocarpal joint were compared between two groups after osteotomy. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were evaluated preoperatively and at the final follow-up. The Nakamura Scoring System (NSSK) was used for comprehensive understanding of radiological and clinical outcomes. RESULTS Nine patients of group A and 11 patients of group B showed radiological improvement in the lunate regarding sclerosis, cystic changes, or fragmentation. No patients showed progression of arthritic changes in radiocarpal and midcarpal joints. The wrist flexion/extension angle, grip strength, and DASH score were significantly improved in both groups after operation, but intergroup difference was not statistically significant at the final follow-up (p = 0.149, p = 0.267, and p = 0.536, respectively). The mean NSSK was 21.6 (range, 15 to 27) in group A and 21.8 (range, 15 to 26) in group B. CONCLUSIONS Radial wedge osteotomy yielded excellent radiological and functional outcomes in advanced stages of Kienböck's disease and these results were comparable to those of Lichtman stage IIIA disease. This technique could be a useful alternative to salvage procedures in the treatment of Lichtman stage IIIB/IV Kienböck's disease without severe radiocarpal arthritis.
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Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Joon Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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26
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Lunate implant arthroplasty: analysis of physical function and patient satisfaction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-016-1248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Özdemir G, Akgül T, Çiçekli Ö, Yılmaz B, Atbinici H, Yücel F. Lunatum excision and scaphocapitate arthrodesis in Kienböck's disease. J Orthop Surg (Hong Kong) 2017; 25:2309499017692704. [PMID: 28219301 DOI: 10.1177/2309499017692704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman's stage IIIB Kienböck's disease. METHODS The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18-54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. RESULTS The mean follow-up period was 17.33 ± 4.69 months (range: 12-24 months), mean operation time was 56.67 ± 12.5 min (range: 45-75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2-6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28-37%) and mean VAS score was 7.6 (range: 7-8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63-81%) and mean VAS score was recorded as 1.4 (range: 1-2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. CONCLUSION Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.
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Affiliation(s)
- Güzelali Özdemir
- 1 Department of Orthopaedics and Traumatology, Ankara Numune Research and Training Hospital, Altındağ, Ankara, Turkey
| | - Turgut Akgül
- 2 Ortopaedics and Traumatology Department, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Özgür Çiçekli
- 3 Department of Orthopaedics and Traumatology, Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Barış Yılmaz
- 4 Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Hasan Atbinici
- 5 Department of Orthopaedics and Traumatology, Sanlıurfa Research and Training Hospital, Sanlıurfa, Turkey
| | - Ferit Yücel
- 5 Department of Orthopaedics and Traumatology, Sanlıurfa Research and Training Hospital, Sanlıurfa, Turkey
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Bain GI, MacLean SBM, Tse WL, Ho PC, Lichtman DM. Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment. J Wrist Surg 2016; 5:255-260. [PMID: 27777814 PMCID: PMC5074828 DOI: 10.1055/s-0036-1584546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
The assessment and management of Kienböck Disease (KD) has always been a conundrum. The Lichtman classification has traditionally been used to guide treatment based on imaging. Arthroscopy provides a direct visualization of the articular surface, allows probing of the surfaces, and enables minimally invasive techniques to be performed. The Lichtman-Bain classification is a new classification that takes into account the osseous, vascular, and cartilage aspects of the lunate and the secondary effects on the wrist. It identifies the important prognostic factors including age, the status of the lunate, and the status of the wrist. With arthroscopy, the articular surfaces of the lunate can be assessed to better understand the status of the lunate. The lunate can be defined as intact, compromised, or not reconstructable. If the lunate is intact then lunate decompression (forage) and arthroscopic assisted bone grafting can be performed. If the lunate facet and capitate are functional, then a proximal carpectomy can be performed. This can be performed as an arthroscopic procedure. Assessment of the wrist includes assessment of the adjacent articular surfaces of the central column articulations (radiocarpal and midcarpal articulations). Instability of the proximal carpal row can also be assessed. The radioscaphoid articulation is often preserved except in late KD, which allows the scaphocapitate fusion to be a good surgical option. This can now be performed as an arthroscopic procedure. Once the radioscaphoid articulation is degenerate, a salvage procedure is required.
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Affiliation(s)
- Gregory I. Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Simon B. M. MacLean
- Flinders Medical Centre, Adelaide, South Australia, Australia
- Department of Orthopaedics, Flinders University, Adelaide, South Australia, Australia
| | - Wing-Lim Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak-Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - David M. Lichtman
- Uniformed Services University, Bethesda, Maryland
- Department of Orthopaedic Surgery, University of North Texas, Health Science Center, Fort Worth, Texas
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White C, Benhaim P, Plotkin B. Treatments for Kienböck disease: what the radiologist needs to know. Skeletal Radiol 2016; 45:531-40. [PMID: 26802001 DOI: 10.1007/s00256-016-2332-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/12/2015] [Accepted: 01/06/2016] [Indexed: 02/02/2023]
Abstract
The etiology of Kienböck disease, or avascular necrosis of the lunate, is controversial, and there are a myriad of treatments aimed at correcting the various hypothesized pathologies. Interventions to reduce mechanical stress on the lunate have been used for decades, including radial osteotomy with or without radial shortening, ulnar lengthening and metaphyseal core decompression procedures. However, these procedures require preservation of lunate architecture. Newer procedures to revascularize the lunate bone have emerged in the last 10 years, such as pedicled corticoperiosteal vascularized bone grafting. Once there is collapse of the radiocarpal joint or midcarpal arthrosis, the conventional treatments have included proximal row carpectomy and complete or partial wrist joint arthrodesis. Newer salvage procedures such as lunate excision with autologous or synthetic interposition grafts are now being used when possible. As this disease is relatively rare, radiologists may not be familiar with the expected post-operative radiologic findings and complications, especially of the newer treatments. The goals of this paper are to review the available treatment options and their expected appearance on postoperative imaging, with discussion of possible complications when appropriate.
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Affiliation(s)
- Carissa White
- Department of Radiology, University of California, Los Angeles, 757 Westwood Blvd. Suite 1638, Los Angeles, CA, 90095, USA.
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10945 Le Conte Ave, Room 33-55 PVUB, Box 957326, Los Angeles, CA, 90095, USA
| | - Benjamin Plotkin
- Department of Radiology, University of California, Los Angeles, 1250 Sixteenth Street, Box 957036, Santa Monica, CA, 90404, USA
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Li C, Su YY, Xu XS, Zhou TH, Fan XY, Xu YQ. Biomechanical Comparison of Two Surgical Methods in Treating Stage IIIb Lunate Necrosis. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Chuan Li
- Department of Orthopedic Surgery, Kunming General Hospital
| | - Yong-Yue Su
- Department of Orthopedic Surgery, Kunming General Hospital
| | - Xiao-Shan Xu
- Department of Orthopedic Surgery, Kunming General Hospital
| | - Tian-Hua Zhou
- Department of Orthopedic Surgery, Kunming General Hospital
| | - Xin-Yu Fan
- Department of Orthopedic Surgery, Kunming General Hospital
| | - Yong-Qing Xu
- Department of Orthopedic Surgery, Kunming General Hospital
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Xu Y, Li C, Zhou T, Su Y, He X, Fan X, Zhu Y. Treatment of Aseptic Necrosis of the Lunate Bone (Kienböck Disease) Using a Nickel-Titanium Memory Alloy Arthrodesis Concentrator: A Series of 24 Cases. Medicine (Baltimore) 2015; 94:e1760. [PMID: 26496298 PMCID: PMC4620833 DOI: 10.1097/md.0000000000001760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Avascular necrosis of the lunate bone (Kienböck disease) is caused by loss of blood supply of the bone. This study aimed to evaluate the efficacy and safety of a novel nickel-titanium (Ni-Ti) memory alloy arthrodesis concentrator in the treatment of this disease.A consecutive 24 patients with stage IIIb aseptic lunate necrosis were treated with scapho-trapezio-trapezoeid (STT) arthrodesis using a Ni-Ti arthrodesis concentrator from August 2008 to December 2012. Wrist pain, grip strength, carpal height, and scapholunate angle were measured and compared before and after the surgery. The wrist functions were evaluated using the Mayo scale.Patients were followed up for a mean of 12 months (range, 6-24 months). Grip strength of the affected side was significantly improved after the surgery (18 ± 4.74 kg vs. 30.21 ± 7.14 kg, P < 0.0001). Wrist pain score was significantly decreased from 5.88 ± 0.9 to 0.5 ± 0.51 (P < 0.0001). Carpal height and Mayo score were also significantly increased after the surgery (P < 0.0001). Scapholunate angle was significantly decreased after the surgery (68.38 ± 7.28° vs. 49.91 ± 4.28°, P < 0.0001). No implant breakage, loose implant, wound infection, or nonunion occurred.STT arthrodesis is effective for the treatment of stage IIIb lunate necrosis. The Ni-Ti memory alloy arthrodesis concentrator is a convenient tool for STT arthrodesis with excellent and reliable results.
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Affiliation(s)
- Yongqing Xu
- From the Department of Orthopedic Surgery, Kunming General Hospital, Kunming, Yunnan, China (YX, CL, TZ, YS, XH, XF, YZ)
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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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Abstract
The human wrist joint is unique from functional and anatomic standpoints. Numerous articulations exist within the wrist that allow for many options for partial wrist fusion and arthroplasty. In cases of pancarpal disease, fusion or arthroplasty of the entire wrist joint can be performed. Because of the high functional demand of the wrist, many of these surgical options can fail, leading to devastating complications. This article addresses the types of fusions and arthroplasties available for the wrist and discusses the potential complications associated with each. Methods to prevent these complications are presented and those to treat them once they have occurred are discussed.
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Affiliation(s)
- Michael P Gaspar
- The Philadelphia Hand Center, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - Patrick M Kane
- The Philadelphia Hand Center, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - Eon K Shin
- The Philadelphia Hand Center, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
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