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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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2
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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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Li X, Lu L, Gong X, Jiang Z. Vascularized Capitate Transposition for the Treatment of Stage IIIB Kienböck Disease. J Hand Surg Am 2020; 45:1085.e1-1085.e11. [PMID: 32829960 DOI: 10.1016/j.jhsa.2020.05.001] [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: 09/07/2018] [Revised: 03/27/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment of Kienböck disease (KD) continues to be controversial. In this study, we report the long-term follow-up outcomes of patients who were diagnosed with stage IIIB KD treated with vascularized capitate transposition. METHODS A total of 16 patients were retrospectively reviewed. Baseline clinical information was extracted from medical records, and wrist function was clinically evaluated, including x-ray images. RESULTS At the final follow-up, wrist pain was severe in 0 patients, moderate in 2 patients, mild in 5 patients, and absent in 9 patients. The mean postoperative active flexion and extension of the affected wrist was significantly improved after surgery compared with before surgery. The postoperative and preoperative mean grip strength was 35 kg and 27 kg, respectively. The Disabilities of the Arm, Shoulder, and Hand score was significantly improved after surgery compared with before surgery. CONCLUSIONS Vascularized capitate transposition for the treatment of Lichtman stage IIIB KD is feasible and associated with improvements in wrist function and pain. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Xiucun Li
- Department of Hand and Foot Surgery, The Second Hospital, Cheelo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhenmin Jiang
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China.
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Deng AD, Innocenti M, Arora R, Gabl M, Tang JB. Vascularized Small-Bone Transfers for Fracture Nonunion and Bony Defects. Clin Plast Surg 2020; 47:501-520. [PMID: 32892797 DOI: 10.1016/j.cps.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vascularized small-bone grafting is an efficient and often necessary surgical approach for nonunion or necrosis of several bones in particular sites of the body, including scaphoid, lunate, distal ulna, and clavicle. The medial femoral condyle is an excellent graft source that can be used in treating scaphoid, ulna, clavicle, or lower-extremity bone defects, including nonunion. Vascularized bone grafting to the small bones, particularly involving reconstruction of damaged cartilage surfaces, should enhance subchondral vascular supply and help prevent cartilage regeneration. Vascularized osteoperiosteal and corticoperiosteal flaps are useful for treating nonunion of long bones.
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Affiliation(s)
- Ai Dong Deng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China
| | - Marco Innocenti
- Plastic Surgery, University of Florence Careggi University Hospital, CTO, Largo Palagi 150139, Florence, Italy
| | - Rohit Arora
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Markus Gabl
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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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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7
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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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8
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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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Ye X, Feng JT, Yin HW, Qiu YQ, Shen YD, Xu WD. Use of 4+5 extensor compartmental vascularized bone graft and K-wire fixation for treating stage II-IIIA Kienböck's disease. HAND SURGERY & REHABILITATION 2020; 39:207-213. [PMID: 32070791 DOI: 10.1016/j.hansur.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
Vascularized bone grafts have shown favorable outcomes in Kienböck's disease, preventing the progression of lunate collapse and avascular necrosis. Here we describe our experience using a 4+5 extensor compartmental artery (ECA) vascularized bone graft combined with K-wire fixation. Between September 2010 and June 2013, 9 patients with Lichtman stage II-IIIA disease underwent arthroscopy prior to 4+5 ECA graft placement combined with temporary fixation (scaphocapitate and triquetrum-capitate joints). The average follow-up was 69 months (range, 51-92 months). Changes in pain, range of motion, grip strength, and pinch strength were analyzed. All patients had satisfactory recovery, especially pain relief and grip strength improvement (both P<0.01). Furthermore, magnetic resonance imaging follow-up was critical for monitoring lunate revascularization, especially in the early postoperative period.
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Affiliation(s)
- X Ye
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - J-T Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - H-W Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China
| | - Y-Q Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China
| | - Y-D Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China.
| | - W-D Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Limb Function Reconstruction Center, Jing'an District Centre Hospital, 259, Xikang road, Jing'an, 200040 Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, No. 12, Middle Wulumuqi road, 200040 Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Fudan University, 138, Yixueyuan road, 200032 Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, 138, Yixueyuan road, 200032 Shanghai, China
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10
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Nayar SK, Marjoua Y, Colon AF, Means KR, Higgins JP. The Effects of Capitate Height Alteration on Dorsal Intercalated Segment Instability. J Wrist Surg 2020; 9:29-33. [PMID: 32025351 PMCID: PMC7000254 DOI: 10.1055/s-0039-1697651] [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: 03/26/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022]
Abstract
Question/Purpose Carpal kinematics may be influenced by the manipulation of carpal dimensions. This may provide a surgical alternative to unpredictable soft tissue reconstruction for scapholunate dissociation. The purpose of this study was to determine if altering capitate height can correct dorsal intercalated segment instability (DISI). Materials and Methods Five cadaveric wrists had baseline radiolunate (RL) angles and scapholunate (SL) intervals measured fluoroscopically, confirming no baseline DISI. We simulated open- and clenched-fist testing via a constant load of the wrist extensors and sequential loading of the digital flexors. We confirmed no baseline static/dynamic DISI. The SL ligament and secondary stabilizers (scapho-trapezio-trapezoid [STT] and dorsal intercarpal ligaments) were transected. Repeat loading and fluoroscopic measurements confirmed creation of static DISI. Capitate height was altered in three interventions: 2 mm shortening osteotomy of capitate waist, 7 mm shortening osteotomy of capitate waist, and 2 mm lengthening of original capitate height by insertion of a spacer at capitate waist. The osteotomized capitate was stabilized with a Kirschner wire; RL angles and SL intervals were measured via fluoroscopy during open- and clenched-fist testing. Primary and secondary outcomes were change in RL angle and SL interval, from the DISI stage to each capitate shortening and lengthening stage. Results SL ligament and secondary stabilizers sectioning created a DISI pattern, with abnormal RL angles (>15°) and widened SL intervals. Neither capitate shortening nor overexpansion corrected RL angles or SL intervals in any DISI-induced wrists. Conclusions Under the conditions studied, isolated capitate shortening or lengthening did not correct radiographic DISI posturing of the lunate following sectioning of the SL and STT interosseous ligaments. Further study of carpal kinematics with more substantial bone changes and loading of adjacent joints may be beneficial. Clinical relevance Surgeons performing capitate shortening osteotomy in isolation should not expect to improve DISI.
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Affiliation(s)
- Suresh K. Nayar
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Youssra Marjoua
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Anthony F. Colon
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Kenneth R. Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - James P. Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
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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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12
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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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13
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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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14
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Li J, Pan Z, Zhao Y, Hu X, Zhao X. Capitate osteotomy and transposition for type III Kienböck's disease. J Hand Surg Eur Vol 2018; 43:708-711. [PMID: 29874977 DOI: 10.1177/1753193418780552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to assess the results of capitate osteotomy and transposition for stage III Kienböck's disease. Capitate osteotomy and transposition combined with an autologous iliac bone graft was carried out in 17 patients. At the final follow-up for a mean of 68 months (range 16-127 months) after surgery, the mean visual analogue scale score was 0.6 (range 0-5). The mean Wrightington wrist function score was 8. The mean grip strength was 79% of the unaffected side. There were 16 satisfactory results. The one unsatisfactory result occurred in a woman who developed a nonunion of the osteotomy. There were no other complications of the surgery. Our results show that capitate osteotomy and transposition is a simple and reliable method for the management of stage III Kienböck's disease. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jianbing Li
- 1 Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,2 Institute of Orthopaedic Research, Zhejiang University, Hangzhou, China
| | - Zhijun Pan
- 1 Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,2 Institute of Orthopaedic Research, Zhejiang University, Hangzhou, China
| | - Yunzhen Zhao
- 3 Department of Orthopaedic Surgery, Jinhua Traditional Chinses Medical Hospital, Jinhua, China
| | - Xinlei Hu
- 1 Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,2 Institute of Orthopaedic Research, Zhejiang University, Hangzhou, China
| | - Xiang Zhao
- 1 Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,2 Institute of Orthopaedic Research, Zhejiang University, Hangzhou, China
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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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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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Nealey EM, Petscavage-Thomas JM, Chew FS, Allan CH, Ha AS. Radiologic Guide to Surgical Treatment of Kienbock's Disease. Curr Probl Diagn Radiol 2017; 47:103-109. [PMID: 28619441 DOI: 10.1067/j.cpradiol.2017.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 11/22/2022]
Abstract
Kienbock's disease, or avascular necrosis of the lunate, is a progressive disease ultimately resulting in end-stage arthrosis of the wrist. Various surgical treatments are available for different Lichtman stages of disease. We review the surgical options and indications, expected radiologic post-operative appearance, as well as detail potential surgical complications, as they relate to Kienbock's disease.
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Affiliation(s)
- Erika M Nealey
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Felix S Chew
- Department of Radiology, University of Washington, Seattle, WA
| | - Christopher H Allan
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - Alice S Ha
- Department of Radiology, University of Washington, Seattle, WA
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Cha SM, Shin HD, Ahn KJ. Prognostic Factors Affecting Union After Ulnar Shortening Osteotomy in Ulnar Impaction Syndrome: A Retrospective Case-Control Study. J Bone Joint Surg Am 2017; 99:638-647. [PMID: 28419031 DOI: 10.2106/jbjs.16.00366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is a widely adopted procedure with excellent outcomes. However, delayed union or nonunion has occasionally been observed. The purpose of this retrospective case-control study was to identify variables affecting osseous consolidation after USO in patients with ulnar impaction syndrome. METHODS The study included 325 patients who had undergone USO between March 2008 and March 2014. We evaluated the association between union and basic demographic factors as well as preoperative pain (assessed on a visual analog scale [VAS]), range of wrist motion, grip strength, and modified Mayo wrist score. We also assessed the association of union with radiographic variables such as the degree of dorsal subluxation of the ulna, preoperative and postoperative ulnar variance, morphological type of the distal radioulnar joint, gap at the osteotomy site, and presence of newly developed arthritic changes during the follow-up period. Finally, variables associated with operative conditions, such as degeneration of the triangular fibrocartilage complex, use of a parallel double-blade saw, type of plate used for fixation, number of screws, and plate position on the volar or dorsal ulnar surface were investigated. RESULTS Ulnar union was achieved in 294 patients (group 1), and 31 patients had delayed union or nonunion (group 2). On univariate and multivariate analyses, smoking, low bone mineral density (BMD), a decreased range of motion of the wrist, and use of a double-blade saw were found to be significant factors for an adverse radiographic outcome (nonunion or delayed union). CONCLUSIONS Delayed union or nonunion occurred in about 10% of patients treated with USO. We suggest that it may be preferable to perform USO in nonsmokers, patients with normal bone density, and those without restricted wrist motion. Also, we recommend the use of a single-blade saw when performing the osteotomy. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Soo Min Cha
- 1Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Luegmair M, Goehtz F, Kalb K, Cip J, van Schoonhoven J. Radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease. J Hand Surg Eur Vol 2017; 42:253-259. [PMID: 28196441 DOI: 10.1177/1753193416676723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We carried out a retrospective study to analyse the long-term outcome of 36 patients after radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease at a mean follow-up of 12.1 years (range 5.4-17.5). At review, seven wrists had progressed to Stage IIIB, eight wrists to Stage IV and 21 remained in Stage IIIA. Motion and grip strength were significantly improved. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score at review was 12 points (range 0-52), and patient satisfaction was high. Apart from plate removals in 14 patients and one wrist denervation, no subsequent surgical procedures were done. Radial shortening yields good long-term clinical results, but does not prevent radiographic progression of disease in some patients. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- M Luegmair
- 1 Department of Orthopaedic Surgery, Medical University of Innsbruck, Zams, Austria
| | - F Goehtz
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
| | - K Kalb
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
| | - J Cip
- 3 Department of Orthopaedic Surgery, Medical University of Innsbruck, Feldkirch, Austria
| | - J van Schoonhoven
- 2 Clinic for Hand Surgery, Rhoen-Klinikum AG, Bad Neustadt/Saale, Germany
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Kadar A, Morsy M, Sur YJ, Laungani AT, Akdag O, Moran SL. The Vascular Anatomy of the Capitate: New Discoveries Using Micro-Computed Tomography Imaging. J Hand Surg Am 2017; 42:78-86. [PMID: 28160904 DOI: 10.1016/j.jhsa.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 12/01/2016] [Accepted: 12/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. METHODS Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points. RESULTS The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. CONCLUSIONS This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. CLINICAL RELEVANCE This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.
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Affiliation(s)
- Assaf Kadar
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Morsy
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt
| | - Yoo-Joon Sur
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Republic of Korea
| | | | - Osman Akdag
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey
| | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN.
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