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.

The association of Kienböck’s disease and ulnar variance in the Iranian population

2012 ◽  
Vol 38 (5) ◽  
pp. 496-499 ◽  
Author(s):  
A Afshar ◽  
A. Aminzadeh-Gohari ◽  
Z. Yekta
Keyword(s):  
General Population ◽  
Adult Population ◽  
Iranian Population ◽  
Ulnar Variance ◽  
Normal Adult ◽  
Disease Group ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
The Mean ◽  
Kienbock’S Disease

We retrospectively determined the distribution of ulnar variance in 60 patients with Kienböck’s disease. We also measured the ulnar variances in 400 standard wrist radiographs in the normal adult population. The mean ulnar variance of the Kienböck’s group was −1.1 mm (SD 1.7) and the mean ulnar variance of the general population was +0.7 (SD 1.5), which was significantly different. In the Kienböck’s disease group there were 38 (63%) with ulnar negative, 16 (27%) neutral and six (10%) with ulnar positive variance. The preponderance of ulnar negative variance was statistically significant. There was an association between ulnar negative variance and the development of Kienböck’s disease in this study.

THE ETIOLOGY OF KIENBÖCK'S DISEASE — A HISTOPATHOLOGICAL STUDY

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 63-69 ◽  
Author(s):  
H.-G. Simank ◽  
M. Schiltenwolf ◽  
W. Krempien
Keyword(s):  
Femoral Head ◽  
Blood Supply ◽  
Primary Lesion ◽  
Histopathological Study ◽  
Arterial Blood Supply ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Arterial Blood ◽  
Kienbock’S Disease

The etiology of the necrosis of the lunate bone is still unclear. In today's theories, the necrosis is explained by impairment of the arterial bone circulation or fracture following mechanical overloading. In this study, six specimen in different stages of the disease were investigated histologically. In all the specimens, focal necrosis was detected, but also signs of regeneration, i.e. immature bone formation. No signs of fracture were seen in all stages of the disease. These findings are not compatible with sudden interruption of arterial blood supply or fracture of the lunate bone as a primary lesion. Comparable histological patterns are known in the necrosis of the femoral head. The etiological model of necrosis of the femoral head is well investigated and postulates primary marrow hypertension, induced by impairment of the venous drainage. Our results are contradictory to the etiological theories of fracture or breakdown of the arterial blood supply as a primary lesion in Kienböck's disease, and support the assumption that the model of intraosseous hypertension is transferable to the necrosis of the lunate bone.

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

2021 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Necmettin Turgut ◽  
Okyar Altas ◽  
Hayati Durmaz
Keyword(s):  
Grip Strength ◽  
Dash Score ◽  
Arthroscopic Debridement ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Hand Grip ◽  
Case Series Study ◽  
The Mean ◽  
Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

History Page: Leaders in MSK Radiology

2021 ◽  
Vol 25 (02) ◽  
pp. 274-276
Author(s):  
Franz Kainberger ◽  
Daniela Hahn
Keyword(s):  
Radiation Oncology ◽  
Scientific Work ◽  
X Rays ◽  
Radiographic Images ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

AbstractRobert Kienböck (1871–1953) may be regarded as one of the first musculoskeletal radiologists who began his clinical and scientific work 2 years after the discovery of X-rays. He lent his name to Kienböck's disease, a traumatic malacia and osteonecrosis of the lunate, and to several other eponyms of diseases, devices, and parameters in radiology and radiation oncology. With his meticulous analysis of radiographic images of the highest quality, he anticipated many theories that were proposed in later decades.

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.

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.

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