Aetiology of Kienböck’s Disease Based on a Study of the Condition among Patients with Cerebral Palsy

1993 ◽  
Vol 18 (3) ◽  
pp. 294-298 ◽  
Author(s):  
S. JOJI ◽  
T. MIZUSEKI ◽  
S. KATAYAMA ◽  
K. TSUGE ◽  
Y. IKUTA
Keyword(s):  
Cerebral Palsy ◽  
Muscle Tone ◽  
Wrist Joint ◽  
Ulnar Variance ◽  
Minor Trauma ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Normal Individuals ◽  
High Prevalence ◽  
Kienbock’S Disease

Examination of 110 patients with cerebral palsy revealed a diagnosis of Kienböck’s disease in six wrists in five cases. All had cerebral palsy of the mixed type with athetosis and high muscle tone. It is considered that the increased prevalence of Kienböck’s disease in these cases was attributable to repeated minor trauma to the lunate from childhood due to high muscle tone across the wrist joint, together with negative ulnar variance. The high prevalence of Kienböck’s disease observed in patients with cerebral palsy strongly suggests that repeated minor trauma together with negative ulnar variance is also the cause of Kienböck’s disease in normal individuals.

scholarly journals Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease

2020 ◽  
Vol 09 (04) ◽  
pp. 276-282
Author(s):  
Gregory I. Bain ◽  
Sathya Vamsi Krishna ◽  
Simon Bruce Murdoch MacLean ◽  
Parth Agrawal
Keyword(s):  
Wrist Joint ◽  
Functional Results ◽  
Salvage Procedure ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Single Screw ◽  
Diagnostic Arthroscopy ◽  
Central Column ◽  
History Of ◽  
Kienbock’S Disease

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.

scholarly journals Evaluation of Kienböck's Disease Treated by Camembert Osteotomy at Seven Years

2019 ◽  
Vol 08 (03) ◽  
pp. 226-233 ◽  
Author(s):  
Emmanuel J. Camus ◽  
Luc Van Overstraeten
Keyword(s):  
Case Series ◽  
Ulnar Variance ◽  
Wedge Osteotomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Ulnar Shortening Osteotomy ◽  
Case Series Study ◽  
Shortening Osteotomy ◽  
Functional Scores ◽  
Kienbock’S Disease

AbstractIn Kienböck's disease, radius shortening osteotomy is the most common treatment. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical symptoms and limits lunate collapse. The series include 10 patients who underwent a Camembert osteotomy for Kienböck's disease between 2002 and 2012 (one bilaterally). They are six men and four women, aged 40.6 years. Five patients had an additional ulnar shortening osteotomy if ulnar variance was neutral or positive. The mean follow-up is 7 years. Preoperatively, range of motion, grip strength, pain, and functional scores were poor. All osteotomies healed within 3 months. Extension, ulnar deviation, grip, functional scores improved significantly. In 10 cases, there were improvement in the T1 and T2 signals on the magnetic resonance imaging (MRI). There was no lunate collapse. This series shows good results with no worsening of the lunate shape. There was no ulnocarpal impingement. The Camembert osteotomy proposes to offload the lunate and redirect strains toward the scaphoid. The supposed interest is to protect the lunate from collapse. In this small series, the Camembert osteotomy improved function in patients with early stage Kienböck's disease. MRI aspects improve in most cases and no patients collapsed. Camembert can be used in combination with a Sennwald's ulnar shortening when ulnar variance is neutral or positive. Authors propose this procedure for Lichtman's stages 1–2–3A if there are no cartilage or ligament lesions. This is a Level IV, case series study.

Kienböck’s Disease in Cerebral Palsy

1998 ◽  
Vol 23 (6) ◽  
pp. 746-748 ◽  
Author(s):  
C. LECLERCQ ◽  
C. XARCHAS
Keyword(s):  
Cerebral Palsy ◽  
Proximal Row Carpectomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

The incidence of Kienböck's disease is known to be higher in cerebral palsy patients, but little has been written on treatment. We report a case of Kienböck's disease in a young man affected by cerebral palsy. A proximal row carpectomy was done, which relieved spasticity at the same time as treating the disease.

The Incidence of Asymptomatic Kienböck’s Disease

2009 ◽  
Vol 34 (3) ◽  
pp. 348-350 ◽  
Author(s):  
U. MENNEN ◽  
H. SITHEBE
Keyword(s):  
Retrospective Study ◽  
Upper Limb ◽  
Ulnar Variance ◽  
African Population ◽  
Aetiological Factor ◽  
Radiology Department ◽  
Dominant Hand ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

The aim of this study was to determine the incidence of asymptomatic Kienböck’s disease in patients who attended the Dr George Mukhari Hospital (formerly Ga-Rankuwa Hospital), as well as the relevance of ulnar variance on the disease. This was a retrospective study. In a 12 month period we reviewed postero-anterior radiographs of 1287 patients seen at our radiology department, with complaints unrelated to the upper limb including the wrist and hand. We identified 23 cases (1.9%) of asymptomatic Lichtman stage II–IV Kienböck’s disease in our African population. The majority (63%) were male with an average age of 49 years, and 37% were female with an average age of 46.5 years. All cases were unilateral and all were in the dominant hand. Thirteen cases (57%) had an ulnar neutral wrist and the remaining ten (43%) had an ulnar negative variance. The vast majority (83%) were unemployed. Analysis of the data shed no further light on the aetiology. The relevance of ulnar variance as an aetiological factor is questioned.

Ulnar Variance in Kienböck’s Disease

1986 ◽  
Vol 11 (2) ◽  
pp. 258-260
Author(s):  
S. S. KRISTENSEN ◽  
E. THOMASSEN ◽  
F. CHRISTENSEN
Keyword(s):  
Bone Formation ◽  
Mean Value ◽  
Observation Time ◽  
Ulnar Variance ◽  
X Rays ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
The Mean ◽  
Kienbock’S Disease

Forty four patients with forty seven wrists suffering from Kienböck’s disease were re-examined. The mean observation time was 20.5 years. In all forty seven wrists the treatment had been immobilization. Using a standard X-ray projection, and a reliable method of ulnar variance measuring, the ulnar variance was determined by three observers independently. Comparing the result with the ulnar variance in normal wrists we found the so-called “ulnar minus variant” overrepresented in patients with Kienböck’s disease. However, comparing X-rays taken at the time of diagnosis with X-rays at re-examination, we found in eight out of forty seven wrists that a subchondral bone formation in the distal radius opposite the lunate bone had taken place. This bone formation will tend to enhance the negative value of ulnar variance measurements, and suggests an explanation of the overrepresentation of “ulnar minus variants” in Kienböck’s disease. Excluding these eight wrists from the material and comparing the mean ulnar variance value in the remaining thirty nine wrists with the mean value in normal wrists no statistical difference was shown. Based on these observations it seems unlikely that the “ulnar minus variant” has any bearing on the cause of Kienböck’s disease.

Kienböck’s Disease in Women

1999 ◽  
Vol 24 (5) ◽  
pp. 596-597 ◽  
Author(s):  
Y. TANIGUCHI ◽  
T. TAMAKI
Keyword(s):  
Wrist Joint ◽  
Age At Onset ◽  
Joint Involvement ◽  
Female Group ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Male Patients ◽  
The Mean ◽  
The Right ◽  
Kienbock’S Disease

We examined 133 patients with Kienböck’s disease, five of whom had bilateral disease. There were 47 women and 86 men. The mean age of patients was 42.7 years (range, 14–80 years). The frequencies of involvement of the right and left sides were approximately equal for women, but male patients tended to have right wrist joint involvement. The side of the affected wrist in the female group differed significantly from that in the male group. The age at onset for women was significantly higher than that for men. The percentage of manual workers was significantly lower among women than among men. The characteristics of Kienböck’s disease in women differed from those in men and those previously reported for this disease. These findings suggest that the pathogenesis of Kienböck’s disease in women differs from that in men.

Lunate trabecular structure: a cadaveric radiograph study of risk factors for Kienböck's disease

2009 ◽  
Vol 35 (2) ◽  
pp. 120-124 ◽  
Author(s):  
K. L. Owers ◽  
P. Scougall ◽  
D. Dabirrahmani ◽  
G. Wernecke ◽  
A. Jhamb ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulnar Variance ◽  
Trabecular Structure ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Articular Surfaces ◽  
Joint Surfaces ◽  
Conventional Ct ◽  
Distal Joint ◽  
Kienbock’S Disease

The aetiology of Kienböck's disease is unknown. Ulnar variance and lunate shape are possible mechanical risk factors. This study assessed the trabecular structure in 29 cadaveric lunates using microCT and correlated this with ulnar variance and lunate shape on plain radiographs and with bone density assessed using conventional CT. The bony trabeculae within the lunate were shown to run almost perpendicular to the proximal and distal joint surfaces in the coronal plane; these trabeculae met the subchondral bone at an angle between 72–102°. In lunates whose proximal and distal articular surfaces are not parallel, the trabecular orientation may be less able to resist compressive forces and more susceptible to fracture.

Sign in / Sign up

Export Citation Format

Share Document