Clinical Outcomes of Patients with Stage II and IIIA Kienböck’s Disease After Undergoing Conservative Management

AbstractKienbock's disease also known as Lunatomalacia is a rare disorder involving the lunate. Damage to the lunate can lead to pain, stiffness, and in late stages, arthritis of the wrist. This disease is most common in men between the ages of 20 and 40 and rarely affects both wrists. Here we present a 35 year old male manual labourer who presented to our department with complaints of progressive pain and stiffness of his dominant wrist.Radiographically he was diagnosed to have Lichtmann class IIIA Kienbock's disease of the left wrist. He was managed with analgesics and wrist physiotherapy. On a review at three months he had an acceptable range of motion of the wrist he was symptom free.This article presents our patients history, radiological findings and management.

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Partial Capitate with/without Hamate Osteotomy in the Treatment of Kienböck's Disease: Influence of the Stage of the Disease on the Midterm Outcome

Journal of Wrist Surgery ◽

10.1055/s-0040-1701509 ◽

2020 ◽

Vol 09 (03) ◽

pp. 249-255

Author(s):

Ahmed Naeem Atiyya ◽

Amr Nabil ◽

Aly Ibrahim Abd El Lattif ◽

Mohamed Nabil El Saied ◽

Ramy Ahmed Soliman

Keyword(s):

Grip Strength ◽

Outcome Measures ◽

Stage Ii ◽

Disease Stage ◽

Type Ii ◽

Stage Iiia ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Early Stages ◽

Kienbock’S Disease

Abstract Objective Moritomo et al introduced partial capitate osteotomy as a treatment modality for early stages of Kienböck's disease. This technique maintains articular contact between the capitate and the scaphoid. We added hamate-shortening osteotomy in addition to partial capitate shortening in cases of lunate type II. The purpose of this study was to evaluate intermediate-term results of partial capitate shortening, investigate the influence of the stage of the disease on the outcome, and assess the clinical and radiological outcomes of adding hamate osteotomy in cases of type II lunate. Patients and Methods A total of 17 consecutive patients (3 women, 14 men) with early stages of Kienböck's disease were prospectively reviewed using the aforementioned technique. Eight patients were in stage II and nine patients were in stage IIIA according to the Lichtman classification system. Clinical outcome measures included pain visual analog score, grip strength and range of motion as a percentage of the unaffected side, and assessment using the Patient-Rated Hand and Wrist Evaluation (PRHWE) and the modified Wrightington Hospital Wrist Score (MWHWS). Radiological outcome measures included healing of the osteotomy site, Stahl index, radioscaphoid angle, and progression of the disease. Results Follow-up period averaged 72 months. All cases of isolated capitate osteotomy and combined capitate and hamate osteotomies united fully. Clinical results revealed significant improvement in pain, grip strength and extension, and PRHWE and MWHWS values. Wrist flexion did not change postoperatively. Patients with stage II showed better overall results and significant MWHWS improvement. Conclusion At the intermediate term, partial capitate with/without hamate shortening is an effective modality for the treatment of patients with early stage Kienböck's disease. Stage II patients showed better results than stage IIIA patients in terms of pain, flexion, grip, PRHWE, and MWHWS. Adding hamate osteotomy may improve the functional results for type II lunate; however, a larger sample is needed to elicit statistical significance. Level of Evidence This is a Level IV, therapeutic study.

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Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures

Journal of Wrist Surgery ◽

10.1055/s-0040-1701511 ◽

2020 ◽

Vol 09 (03) ◽

pp. 197-202 ◽

Cited By ~ 1

Author(s):

Joshua A. Gillis ◽

Joseph S. Khouri ◽

Steven L. Moran

Keyword(s):

Grip Strength ◽

Surgical Management ◽

Conservative Management ◽

Retrospective Chart Review ◽

Level Of Evidence ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Adolescent Patients ◽

Revascularization Procedures ◽

Kienbock’S Disease

Abstract Objective To evaluate the outcomes and complication rate of surgical management in adolescent patients with Kienböck's disease and compare lunate offloading and revascularization procedures. Methods We performed a retrospective chart review to evaluate adolescent patients with Kienböck's disease between 1990 and 2016 who were surgically managed. Charts were reviewed for demographic information, presence of trauma, range of motion, grip strength, and radiographic parameters pre- and postoperative. Results We assessed 21 wrists in 20 patients. All had failed conservative management and required surgery. Seven patients underwent lunate offloading procedures, most commonly radial-shortening osteotomy, whereas 13 patients had an attempt at revascularization. All patients had either minimal or no pain at a clinical mean clinical follow-up of 63.4 months. Postoperatively, grip strength and radial deviation improved, with no difference between the two groups. Those that underwent joint offloading procedures had less ulnar variance. Eight of 11 patients with a postoperative MRI (magnetic resonance imaging) had evidence of lunate revascularization after a revascularization procedure. Conclusion Surgical management of Kienböck's disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management. Level of Evidence/Type of study This is a Level IV, therapeutic study.

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