Changes in Carpal Alignment Following Radial Osteotomy for Kienböck’s Disease

1993 ◽  
Vol 18 (3) ◽  
pp. 289-293 ◽  
Author(s):  
K. TSUNODA ◽  
R. NAKAMURA ◽  
K. WATANABE ◽  
E. HORII ◽  
T. MIURA
Keyword(s):  
Clinical Outcome ◽  
Contact Area ◽  
Axial Load ◽  
Height Ratio ◽  
Distance Ratio ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Carpal Height ◽  
Kienbock’S Disease

Changes in carpal alignment following radial osteotomy were studied in 30 patients with Kienböck’s disease. The carpal height ratio and carpal-ulnar distance ratio were significantly less in wrists with Kienböck’s disease than unaffected wrists. This observation implies proximal-ulnar translation of the capitate. In addition, the lunate-covering ratio increased significantly, reflecting radial translation of the lunate. Radial osteotomy corrected ulnar translation of the capitate and increased the radial translation of the lunate, thus increasing the lunate-covering ratio. The increased lunate-covering ratio is believed to increase the area of distribution of the axial load through the lunate by increasing the contact area with the radius. The satisfactory clinical outcome of radial osteotomy is believed to be due to this effect on carpal alignment.

scholarly journals Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?

2019 ◽  
Vol 09 (01) ◽  
pp. 039-043
Author(s):  
Arvind Mohan ◽  
Richard Knight ◽  
Hiba Ismail ◽  
Ian A. Trail
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ulnar Variance ◽  
Height Ratio ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
X Ray ◽  
Kienböck's Disease ◽  
Carpal Height ◽  
Kienbock’S Disease

AbstractCarpal height ratio and ulnar variance on plain X-ray were measured and compared to the width/height ratio of the lunate as measured on a computed tomography (CT) scan in 50 patients with Kienböck's disease. Width/height ratio of the lunate was also measured in a series of 50 controls. No correlation between ulnar variance and fractures was found. Conversely, the correlation between carpal height ratio on X-ray and width/height ratio on a CT scan was statistically significant. Similarly, the correlation between ulnar variance and width/height ratio was statistically significant. We have concluded that width/height ratio while correlating with carpal height is a better measure of lunate collapse. It also appeared that lunate collapse precedes carpal collapse, specifically most if not all lunates have collapsed prior to reduction in carpal height ratio. Finally, while we are unable to conclude the level at which the width/height ratio of lunate becomes unreconstructable, it does appear that in all Litchman stage 3b and most if not all of 3a the shape of the lunate has altered significantly.

scholarly journals Extensor carpi radialis longus tendon ball interposition arthroplasty for treatment of late-stage Kienböck’s disease: Short-term results of a novel technique

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880251
Author(s):  
Okan Aslantürk ◽  
Kadir Ertem ◽  
Emre Ergen ◽  
Muhammed Köroğlu
Keyword(s):  
Late Stage ◽  
Visual Analog Scale Score ◽  
Height Ratio ◽  
Short Term ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Extensor Carpi Radialis ◽  
Carpal Height ◽  
Kienbock’S Disease

Purpose: The aim of this study was to evaluate short-term clinical and radiological results of extensor carpi radialis longus (ECRL) tendon ball arthroplasty for treatment of late-stage Kienböck’s disease. Methods: We retrospectively reviewed data of 19 patients suffering from Kienböck’s treated with ECRL tendon ball arthroplasty between December 2014 and December 2016. Patients’ clinical functions were assessed using grip strength, range of motion (ROM) of the wrist, QuickDASH, Mayo wrist score, and visual analog scale score. Radiological examination was performed to assess carpal height ratio and progression of arthritis. Results: The median follow-up was 30 months (range, 12–36 months). At final follow-up, ROM of operated wrist was 71% of the nonoperated side. Thirteen (86.6%) patients were pain free. Carpal height ratio was statistically significantly reduced compared with preoperative values. All patients declared their satisfaction with the results due to their preoperative status. Conclusions: ECRL tendon ball arthroplasty is a new and good option for treatment of late-stage Kienböck’s disease with low complication rate.

Stage 3 KienbÖck’s Disease: Reconstruction of the Fractured Lunate using a Free Vascularized Iliac Bone Graft and External Fixation

2002 ◽  
Vol 27 (4) ◽  
pp. 369-373 ◽  
Author(s):  
M. GABL ◽  
M. LUTZ ◽  
Cl. REINHART ◽  
R. ZIMMERMANN ◽  
S. PECHLANER ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Necrotic Core ◽  
Iliac Bone ◽  
The Other ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Iliac Bone Graft ◽  
Kienbock’S Disease

Eighteen patients with stage 3 Kienböck’s disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.

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.

scholarly journals Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck's Disease

2017 ◽  
Vol 9 (3) ◽  
pp. 355 ◽  
Author(s):  
Young Ho Shin ◽  
Jihyeung Kim ◽  
Hyun Sik Gong ◽  
Seung Hwan Rhee ◽  
Min Joon Cho ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Wedge Osteotomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Advanced Stages ◽  
Kienbock’S Disease

Long-term clinical results and MRI changes after tendon ball arthroplasty for advanced Kienböck’s disease

2013 ◽  
Vol 38 (5) ◽  
pp. 508-514 ◽  
Author(s):  
M. Mariconda ◽  
E. Soscia ◽  
C. Sirignano ◽  
F. Smeraglia ◽  
A. Soldati ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Cartilage Damage ◽  
Clinical Results ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Mri Changes ◽  
Carpal Height ◽  
Kienbock’S Disease

The purpose of this study was to assess the long-term clinical results and morphological changes after tendon ball arthroplasty for advanced Kienböck’s disease. Twenty-six patients were reviewed, with a mean follow-up interval of 125 months (range 50–226). At follow-up, mean score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 7.7 and mean visual analogue scale score for pain was 1. Mean carpal height ratio was significantly reduced with respect to the pre-operative value. On magnetic resonance imaging scans, cartilage damage, synovitis, and erosive or oedematous changes in the bones were detected in most patients. Calcification in the defect filled by the tendon ball was seen in all patients. Narrowing of the radioscaphoid joint and the presence of intercarpal synovitis were negatively associated with clinical outcome. Tendon ball arthroplasty in advanced Kienböck’s disease results in long-term satisfactory clinical outcomes, despite widespread changes in the bones and joints within the wrist.

Scapho-Trapezio-Trapezoid Arthrodesis in the Treatment of Kienböck’s Disease

1992 ◽  
Vol 17 (1) ◽  
pp. 5-11 ◽  
Author(s):  
P. VOCHE ◽  
C. BOUR ◽  
M. MERLE
Keyword(s):  
Grip Strength ◽  
Clinical Results ◽  
Prosthetic Replacement ◽  
Radiographic Assessment ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Flexion Extension ◽  
Carpal Height ◽  
Kienbock’S Disease

Sixteen scapho-trapezio-trapezoid arthrodeses were performed for Kienböck’s disease. In ten cases, a prosthetic replacement of the lunate was inserted at the same time. Clinical results were good with regard to pain and fair with regard to grip strength which was improved by an average of 32%. In contrast, the arc of flexion-extension was 38% less than on the unoperated side. Long-term radiographic assessment showed the efficacy of the procedure in maintaining carpal height. Biomechanical observations and a review of poor results showed the limits of the method and the importance of correct positioning of the scaphoid. We concluded that triscaphe arthrodesis was a useful procedure for the treatment of Kienböck’s disease in Decoulx’s stage 3.

CLINICAL OUTCOMES OF EXCISION ARTHROPLASTY FOR KIENBOCK'S DISEASE

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 277-282 ◽  
Author(s):  
Tomoya Matsuhashi ◽  
Norimasa Iwasaki ◽  
Hiroyuki Kato ◽  
Michio Minami ◽  
Akio Minami
Keyword(s):  
Clinical Score ◽  
Clinical Results ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Radiocarpal Joint ◽  
The Mean ◽  
Excision Arthroplasty ◽  
Carpal Height ◽  
Kienbock’S Disease

We have carried out a replacement of the lunate in 12 patients with advanced Kienböck's disease, with excision of the lunate and insertion of an iliac bone flap wrapped into palmaris longus. The aims of this study were to determine the effect of this procedure for advanced Kienböck's disease. At a mean follow-up period of 45.3 months, the mean clinical score was excellent in all cases. Radiographically, progression of osteoarthritis (OA) in the radiocarpal joint was found in two patients. At follow-up, the X-ray findings indicated a reduced of osseous core in four patients. On the other hand, carpal height ratio showed no significant change at follow-up. Excision arthroplasty using a tendon ball with osseous core for advanced Kienböck's disease leads to OA progression in some cases. However, clinical results were excellent in all cases. Therefore, this current study provides effective therapeutic procedure for advanced Kienböck's disease.

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