Capitate shortening osteotomy with or without vascularized bone grafting for the treatment of early stages of Kienböck’s disease

2021 ◽  
Author(s):  
Galal Hegazy ◽  
Mahmoud Seddik ◽  
Abdel-Hakim Massoud ◽  
Rashed Imam ◽  
Ehab Alshal ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Shortening Osteotomy ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Kienböck’s Disease, Early Stage 3––Height Reconstruction and Core Revascularization of the Lunate

1994 ◽  
Vol 19 (4) ◽  
pp. 466-478 ◽  
Author(s):  
R. C. BOCHUD ◽  
U. BÜCHLER
Keyword(s):  
Bone Grafting ◽  
Early Stage ◽  
Disease Process ◽  
Wrist Motion ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Shortening Osteotomy ◽  
Final Score ◽  
Carpal Height ◽  
Kienbock’S Disease

Early stage 3 Kienböck’s disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases. 26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5–9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI. Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%. Overall, 43% good and excellent, 43% fair and 14% poor results were observed.

ARTHROSCOPIC ASSISTED BONE GRAFTING FOR EARLY STAGES OF KIENBÖCK'S DISEASE

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 127-131 ◽  
Author(s):  
L. Pegoli ◽  
A. Ghezzi ◽  
E. Cavalli ◽  
R. Luchetti ◽  
G. Pajardi
Keyword(s):  
Bone Grafting ◽  
Normal Density ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Number Of Patients ◽  
First Choice ◽  
Choice Of Treatment ◽  
Kienbock’S Disease

Kienböck's disease is known for its difficulty in being diagnosed and treated at early stages; option treatments are few and most of them quite aggressive. The author describes his experience with arthroscopic assisted lunate bone grafting. Three patients with diagnosis of stage I avascular necrosis of the lunate (average age: 45 years), were treated. Before surgical procedure, the patients underwent to a conservative treatment. After harvesting the bone graft from the volar surface of the radius, arthroscopic bone grafting was performed. At an average follow-up of 13.5 months (9–15), all the patients show a normal density of the lunate and no arthritic changes in radiographs. The MRI confirmed the lunate vascularity. The number of patients is definitely small, due also to the rarity of the disease and the difficulty in diagnosis, but, despite the very high learning curve, could be the proper first choice of treatment.

scholarly journals Systematic review of Surgical Management of Early Stages of Kienböck’s Disease

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A K H Abouelela ◽  
A Nabil ◽  
M A Lami
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Range Of Motion ◽  
Core Decompression ◽  
Vascularized Bone Graft ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Abstract Background Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft. Objective To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease. Methodology The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications. Results This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score. Conclusion Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.

scholarly journals Kuhlmann vascularized bone grafting for treatment of Kienböck’s disease: a case report

2016 ◽  
Vol 24 ◽  
Author(s):  
Mohamed Ali Sbai ◽  
Hichem Msek ◽  
Sofien Benzarti ◽  
Monia Boussen ◽  
Riadh Maalla
Keyword(s):  
Case Report ◽  
Bone Grafting ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Capitate shortening osteotomy and vascularized bone grafting for Kienböck’s disease in ulnar positive or neutral wrists

2021 ◽  
pp. 175319342199991
Author(s):  
Alistair R. Hunter ◽  
David Temperley ◽  
Ian A. Trail
Keyword(s):  
Medium Term ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Evaluation Scores ◽  
Shortening Osteotomy ◽  
Functional Scores ◽  
Mri Scans ◽  
Vascularized Bone ◽  
Kienbock’S Disease

We report the short- to medium-term outcomes for patients with Kienböck’s disease and ulnar positive or neutral wrists treated by capitate shortening osteotomy combined with a 4 + 5 extensor compartmental artery vascularized bone graft placed in the lunate. This is a retrospective study of seven consecutive patients with Lichtman Stage 2 to 3B. Radiological and clinical outcomes were evaluated. Six patients maintained their Lichtman stage, one progressed. Mean time to union of the capitate was 10 weeks. Five of six lunates were completely revascularized on MRI scans, with one partial revascularization. Mean follow-up for functional scores was 40 months (range 15 to 62). Mean pain score improved significantly from 7.4/10 preoperatively to 1.9/10 postoperatively, and patient satisfaction was 9.2/10. Mean postoperative Quick Disabilities of Arm, Shoulder and Hand, Patient Evaluation Measure and Patient-Rated Wrist Evaluation scores were improved. All patients returned to their previous work. We conclude that this procedure has good short- to medium-term outcomes. Level of evidence: IV

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