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Heifner JJ, Halpern AL, Zavurov G, Mercer DM. Novel Descriptions of the Radial Osteotomy in Kienböck's Disease: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:401-406. [PMID: 37521551 PMCID: PMC10382875 DOI: 10.1016/j.jhsg.2023.01.008] [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: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Kienböck's disease consists of intrinsic and extrinsic characteristics that coalesce into a pathology with multifactorial etiology. Mechanical, morphological, and vascular factors have been identified as contributory. Radial osteotomy is one of the most commonly used surgical treatment for late-stage Kienböck's disease. Despite its frequent use and reported value, the specifics of radial osteotomy have not been described in aggregate. Our objective was to review the recent literature for descriptions of the radial osteotomy techniques used for treatment of Kienböck's disease. Methods The inclusion criteria for the systematic review were as follows: (1) patients aged >18 years, (2) a publication date no older than 2012, and (3) a complete description of the distal radius osteotomy technique, including verbiage that specified numeric dimensions of bony resection or verbiage that detailed a goal in terms of a radiographic parameter that would guide the bony resection. Results The studies were grouped according to the stated description of radial osteotomy. This process yielded the following three main groups: (1) studies that used radial shortening, (2) studies that used lateral closing wedge osteotomy or combined lateral closing wedge with radial shortening, and (3) novel osteotomy descriptions. Conclusions The Kienböck's disease literature predominantly describes an osteotomy to shorten the radius by 2-3 mm. In some studies, the degree of radial shortening corresponded to the value necessary to achieve near-neutral ulnar variance. The common goal in using lateral closing wedge osteotomy was to achieve a radial inclination of 5° to 15°. Unique wedge resections, some with multiplanar corrections, have been recently described with each purporting specific advantages. Clinical relevance Our findings support the premise of mechanical and biologic efficacy for radial osteotomy, with satisfactory results being reported across a wide spectrum of osteotomy techniques.
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Affiliation(s)
- John J. Heifner
- St George’s University School of Medicine, Great River, NY
- Miami Bone and Joint Institute - Hand Institute, Miami, FL
| | - Abby L. Halpern
- Department of Orthopaedic Surgery, Larkin Hospital, Miami, FL
| | | | - Deana M. Mercer
- Department of Orthopaedics & Rehabilitation; University of New Mexico, Albuquerque, NM
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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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Unal KO, Bingol O, Korucu A, Kilic E, Ozdemir G, Akinci M. Medium-term clinical and radiological results of surgically treated stage 3A Kienböck's disease. HAND SURGERY & REHABILITATION 2021; 40:737-743. [PMID: 34246814 DOI: 10.1016/j.hansur.2021.07.002] [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: 02/04/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to compare the methods of distal radial shortening osteotomy (RSO), lateral closing distal radial wedge osteotomy (RWO), and scaphotrapeziotrapezoid (STT) fusion in the treatment of stage 3A Kienböck's disease (KD). The research was planned as a single-center and retrospective study for the period 2008-2018. Patients were allocated to three groups according to surgical method: group 1, patients with negative ulnar variance, undergoing RSO; group 2, patients with non-negative (neutral or positive) ulnar variance, undergoing RWO; and group 3, patients with non-negative ulnar variance, undergoing STT fusion. Radiological measurements were compared: pre- and postoperative Stahl index, radioscaphoid angle, and carpal height ratio. Clinical comparison used QuickDASH and modified Mayo wrist scores. Fifty-one patients, with a mean age of 34 ± 12 years (range; 16-69 years), were included. Mean follow-up was 4.47 ± 1.8 (range 2-9) years. No statistically significant difference was observed between the groups in terms of change in carpal height ratio or Stahl index (respectively; P = 0.08, P = 0.065). A significant difference was observed in change in radioscaphoid angle between patients undergoing STT fusion versus RWO (P < 0.05). There was no statistically significant difference in postoperative functional scores between groups, and similar postoperative functional scores were achieved with STT fusion and with RWO in the surgical treatment of stage 3A KD with positive or neutral ulnar variance. Good medium-term radiological and clinical results were obtained with RSO in patients with stage 3A KD with negative ulnar variance.
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Affiliation(s)
- Kazim Onur Unal
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Olgun Bingol
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey.
| | - Alperen Korucu
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Enver Kilic
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Guzelali Ozdemir
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Metin Akinci
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
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Lee JH, Son J, Park MJ. Clinical Outcomes of Patients with Stage II and IIIA Kienböck's Disease After Undergoing Conservative Management. Indian J Orthop 2021; 56:79-86. [PMID: 35070146 PMCID: PMC8748577 DOI: 10.1007/s43465-021-00451-0] [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: 11/17/2020] [Accepted: 06/27/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The current study aimed to demonstrate the outcomes of patients with Lichtman stage II and IIIA Kienböck's disease with mild pain and good range of motion (ROM) after conservative management. We hypothesized that we can conservatively manage patients with early-stage Kienböck's disease including those with stage IIIA. PATIENTS AND METHODS This study is a retrospective case series. Between January 2012 and December 2017, 38 patients were enrolled in this study. The mean follow-up period of conservatively managed group was 49.1 months. The flexion-extension (FE) arc, grip strength, Pain Visual Analog Scale (pVAS), Modified Mayo Wrist Score (MMWS), and disabilities of the arm, shoulder, and hand (DASH) score were determined for functional evaluation. The radiographic parameters were assessed using the Stahl's index and carpal height ratio. The morphological changes in the lunate were also evaluated with plain radiographs. RESULTS A total of 31 of 38 patients (81.6%) showed favorable outcomes after conservative treatment. The mean pVAS score, MMWS, and DASH score showed statistically significant improvement, as well as the morphology of lunates on the plain radiograph. The mean FE arc was slightly decreased without statistical significance. The grip strength showed improvement with statistical significance. One patient showed the same radiographic morphology, but did not manifest any pain. A total of five (13.2%) patients who experienced aggravated pain and decreased ROM underwent surgical treatment. The other patient required surgical intervention but was provided conservative treatment due to her circumstances. CONCLUSION Favorable outcomes can be expected in patients with Lichtman stages II and IIIA avascular necrosis of the lunate (Kienböck's disease) with mild pain and good ROM who undergo conservative management. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopedic Surgery, Medical College of Hallym University, Hallym University Sacred Heart Hospital, Chuncheon, 14068 Republic of Korea
| | - JangWon Son
- Department of Orthopedic Surgery, Medical College of Hallym University, Hallym University Sacred Heart Hospital, Chuncheon, 14068 Republic of Korea
| | - Min-Jong Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 Republic of Korea
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van Leeuwen WF, Pong TM, Gottlieb RW, Deml C, Chen N, van der Heijden BE. Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome. J Wrist Surg 2021; 10:17-22. [PMID: 33552689 PMCID: PMC7850797 DOI: 10.1055/s-0040-1714750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck's disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments. Patients and Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck's disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction. Results We included 48 patients who had radial shortening osteotomy alone, and 17 patients who had a combined procedure of radial shortening and direct revascularization. The rate of unplanned reoperations was 33% (16 of 48) in those who had radial shortening osteotomy and 24% (4 of 17) in those who had a combined procedure. Six (13%) of 48 patients underwent proximal row carpectomy due to failed radial shortening osteotomy. No salvage procedures were performed after combined radial shortening/revascularization. Median PROMIS Physical Function CAT scores were 56 (interquartile range [IQR]: 44-56) and 56 (IQR: 41-56), respectively. Median PROMIS Pain Interference scores were 39 (IQR: 39-52) and 39 (IQR: 39-49), respectively. Median QuickDASH scores were 2.3 (IQR: 0-23) and 4.5 (IQR: 2.3-14), respectively. Conclusion Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function. We observed that approximately one in eight patients underwent salvage surgery after radial shortening, and this should be taken into account when making the initial decision to treat Kienböck's disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Wouter F. van Leeuwen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Taylor M. Pong
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
| | - Rachel W. Gottlieb
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
| | - Christian Deml
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Neal Chen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
| | - Brigitte E.P.A. van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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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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Goyal N, Singh V, Barik S, Behera S. Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis. J Wrist Surg 2020; 9:404-410. [PMID: 33042643 PMCID: PMC7540655 DOI: 10.1055/s-0040-1712517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.
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Affiliation(s)
- Nikhil Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Santosh Behera
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Ruettermann M. Lunate excision, capitate osteotomy, and intercarpal arthrodesis should be used with caution for advanced Kienböck's disease. J Hand Surg Eur Vol 2019; 44:112-113. [PMID: 30798686 PMCID: PMC6327302 DOI: 10.1177/1753193418807360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mike Ruettermann
- University Medical Center Groningen, UMCG, Groningen, The Netherlands,HPC, Oldenburg Institute for Hand- and Plastic Surgery, Oldenburg, Germany,
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Tan Z, Xiang Z, Huang F, Yang Z, Xiao C, Duan X. Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years: A case series. Medicine (Baltimore) 2018; 97:e13229. [PMID: 30508905 PMCID: PMC6283118 DOI: 10.1097/md.0000000000013229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches, reports on long-term follow-up and case series for this technique are scarce.We collected postoperative results in 11 patients with advanced Kienböck disease who underwent VOPT between 1986 and 2001 in our Hospital. Follow-up durations ranged from 15 to 26 years.At the last follow-up, excellent and good results were found in 81.8% according to the Modified Green and O'Brien score. Postoperative imaging revealed significantly reduced pisiform bone; carpal height ratio and Nattrass index were decreased, while the radioscaphoid angle was increscent, compared with preoperative and mid-term follow-up results.The favorable long-term results demonstrated that VOPT is a dependable and durable procedure for the treatment of advanced Kienböck disease, with pain relief and functional improvement despite some radiographic findings such as wrist osteoarthritis occurrence.
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Shin YH, Kim JK, Han M, Lee TK, Yoon JO. Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review. J Bone Joint Surg Am 2018; 100:1231-1240. [PMID: 30020130 DOI: 10.2106/jbjs.17.00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease. METHODS We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies. RESULTS Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°). CONCLUSIONS Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young Ho Shin
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Kwang Kim
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minkyu Han
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Kyoon Lee
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun O Yoon
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Yesiloz M, Louis M, DeVerbizier J, Dautel G, Dap F, Blum A, Teixeira PG. Kienböck's disease: Role of cross-sectional imaging in treatment choice and patient follow-up. Eur J Radiol 2018; 105:269-282. [PMID: 30017293 DOI: 10.1016/j.ejrad.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/09/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Abstract
The management of Kienböck's disease is complex and constantly evolving in parallel with progress in the understanding of the pathophysiological mechanisms of this condition. Cross-sectional imaging techniques have an essential role in the diagnosis and prognostic assessment of this disease. CT allows the optimal study of the morpho-structure of lunate bone. MRI makes it possible to study bone marrow viability. As for CT arthrography, it allows to evaluate accurately articular cartilage of the different carpal joints. The evaluation of these different aspects of Kienböck's disease is essential for optimal treatment selection. Cross-sectional imaging also has an interest in post-treatment follow-up, by having a prognostic value and allowing the identification of post-operative complications. The purpose of this article is to review the contribution of cross-sectional imaging in the assessment of Kienböck's disease before and after treatment according to the most common surgical procedures. Pathophysiological mechanisms, predisposing factors, the different classifications and their interests will be discussed.
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Affiliation(s)
- Muhammed Yesiloz
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - Matthias Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Jacques DeVerbizier
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Gilles Dautel
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - François Dap
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - Alain Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
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12
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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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De Carli P, Zaidenberg EE, Alfie V, Donndorff A, Boretto JG, Gallucci GL. Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up. J Hand Surg Am 2017; 42:752.e1-752.e6. [PMID: 28666672 DOI: 10.1016/j.jhsa.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 05/02/2017] [Accepted: 05/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE This study was designed to analyze the long-term clinical and radiological outcomes of a series of patients with Kienböck disease stage IIIA treated with radius core decompression. METHODS This retrospective study included 15 patients with Kienböck disease (Lichtman stage IIIA) who underwent distal radius metaphyseal core decompression between 1998 and 2005 and who were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analog scale pain score. We also compared the radiological changes between the preoperative and the final follow-up in their Lichtman classification and the modified carpal height ratio. RESULTS The mean follow-up period was 13 years (range, 10-18 years). Based on the modified Mayo wrist score, clinical results were excellent in 6 patients, good in 8 patients, and poor in 1 patient who required a proximal row carpectomy as revision surgery. The mean preoperative pain according to the visual analog scale was 7 (range, 6-10) and was 1.2 (range, 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 77% and the grip strength was 80%. All patients, except 1, returned to their original employment. At the final follow-up, 3 patients had decreased modified carpal height ratio, 12 remained unchanged. Radiographic disease progression according to the Lichtman classification to stages IIIB to IV occurred in only 2 wrists. There were no complications related to the core decompression. CONCLUSIONS In this limited series, the radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage IIIA of Kienböck disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Pablo De Carli
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | - Veronica Alfie
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Agustin Donndorff
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | - Gerardo Luis Gallucci
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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