Proximal Row Carpectomy Versus Limited Wrist Arthrodesis for Advanced Kienböck’s Disease

1998 ◽  
Vol 23 (6) ◽  
pp. 741-745 ◽  
Author(s):  
R. NAKAMURA ◽  
E. HORII ◽  
K. WATANABE ◽  
E. NAKAO ◽  
H. KATO ◽  
...  
Keyword(s):  
Grip Strength ◽  
Wrist Pain ◽  
Wrist Flexion ◽  
Proximal Row Carpectomy ◽  
Wrist Arthrodesis ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Flexion Extension ◽  
Kienbock’S Disease

The outcomes in 20 patients with advanced Kienböck's disease treated by proximal row carpectomy (seven patients) or limited wrist arthrodesis (13 patients) were reviewed retrospectivey. Postoperatively, the results were more satisfactory in terms of wrist pain, the range of wrist flexion–extension, and grip strength following limited wrist arthrodesis than after proximal row carpectomy, although the differences were not statistically significant. We recommend scaphotrapeziotrapezoid arthrodesis in selected patients with advanced Kienböck's disease who have a fragmented lunate.

LIMITED WRIST ARTHRODESIS VERSUS RADIAL OSTEOTOMY FOR ADVANCED KIENBÖCK'S DISEASE — FOR A FRAGMENTED LUNATE

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 9-14 ◽  
Author(s):  
Masahiro Tatebe ◽  
Hitoshi Hirata ◽  
Yoshihisa Iwata ◽  
Tatsuya Hattori ◽  
Ryogo Nakamura
Keyword(s):  
Surgical Treatment ◽  
Return To Work ◽  
Wrist Flexion ◽  
Carpal Collapse ◽  
Wrist Arthrodesis ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Active Flexion ◽  
Flexion Extension ◽  
Kienbock’S Disease

Thirty-eight patients with advanced Kienböck's disease treated by limited wrist arthrodesis (LWA: n = 10) or radial osteotomy (RO: n = 28) for a fragmented lunate were retrospectively examined after an average of 47.9 and 68.1 months, respectively. Compared with pre-operative values, the active flexion-extension range of motion decreased by about 16.0° in LWA and increased approximately 9.7° in RO and the grip strength improved by approximately 7.5 kg in LWA and 8.0 kg in RO. In both groups, radiographs showed no significant progression of carpal collapse. Although LWA caused some decrease in wrist flexion-extension, both procedures are appropriate for surgical treatment of advanced Kienböck's disease. Most patients experienced a reduction in pain and were able to return to work.

scholarly journals Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

2019 ◽  
Vol 5 (6) ◽  
pp. 1025
Author(s):  
Hossam Elden A. Abodonia ◽  
Mohammed H. Elbadawy ◽  
Ahmed A. Basha
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Positive Impact ◽  
Contralateral Side ◽  
Stage Iii ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Flexion Extension ◽  
The Mean ◽  
Kienbock’S Disease

<p class="abstract"><strong>Background:</strong> Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment option for stage III Kienbock’s disease.</p><p class="abstract"><strong>Methods:</strong> This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a lawyer. The average follow up period was 14.2 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5. Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90 mmHg representing 93.2% of the contralateral side.</p><p><strong>Conclusions:</strong> Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion.</p>

Excessive Radial Shortening in Kienböck’s Disease

1990 ◽  
Vol 15 (1) ◽  
pp. 46-48
Author(s):  
R. NAKAMURA ◽  
E. HORII ◽  
T. IMAEDA
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Wrist Pain ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Ulnar Wrist Pain ◽  
And Function ◽  
Kienbock’S Disease

Two patients with Kienböck’s disease who had been treated by radial shortening developed ulnar wrist pain post-operatively due to excessive radial shortening. In both cases, ulnar shortening was required to improve symptoms and function. Excessive radial shortening can cause ulnar wrist pain and compromise the improvement of grip strength and range of motion of 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.

scholarly journals Descompresión ósea metafisaria del radio distal para estadios tempranos de la enfermedad de Kienböck. Seguimiento mínimo de 10 años. [Metaphyseal bone decompression of distal radius for early stages of Kienböck's disease. Minimum follow-up of 10 years.]

10.15417/757 ◽  
2018 ◽  
Vol 83 (1) ◽  
pp. 25
Author(s):  
Ezequiel Ernesto Zaidenberg ◽  
Pablo De Carli ◽  
Jorge Guillermo Boretto ◽  
Agustin Donndorff ◽  
Veronica Alfie ◽  
...  
Keyword(s):  
Distal Radius ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Flexion Extension ◽  
Metaphyseal Bone ◽  
Kienbock’S Disease

<p><strong>Introducción</strong></p><p><strong></strong>El objetivo de este trabajo es analizar los resultados clínicos y radiológicos a largo plazo de una serie de pacientes con enfermedad de Kienböck en estadios II y IIIA  de la clasificación de Lichtman, tratados mediante descompresión metafisaria del radio distal.<strong> </strong></p><p><strong>Materiales y Métodos</strong></p><p><strong></strong>Este estudio retrospectivo y descriptivo incluyó a 23 pacientes con enfermedad de Kienböck (estadios II y IIIA de Lichtman) tratados mediante descompresión metafisaria del radio distal con al menos 10 años de seguimiento. Al final del seguimiento, los pacientes fueron evaluados para el rango de movimiento de muñeca, fuerza de puño, escala de Mayo modificada y el dolor, según la escala visual analógica (EVA). Se valoró radiográficamente según la clasificación de Lichtman y el índice de altura carpiana (IAC).</p><p><strong>Resultados</strong></p><p><strong></strong>El seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II.<strong> </strong>Basado en la escala de Mayo, los resultados fueron excelentes en 9 pacientes, buenos en 11 pacientes, moderados en 2 y pobres en un paciente. La EVA preoperatoria fue 7 (rango 6-10) y fue 1,1 (rango 0-6) en el seguimiento final. El arco de flexión/extensión promedio fue del 78% y la fuerza de puño del 81%. Según la clasificación de Lichtman se produjo progresión en 4 pacientes mientras que los otros 19 pacientes permanecieron en la misma etapa que en el preoperatorio.<strong> </strong></p><p><strong>Conclusión</strong></p><p><strong></strong>La descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck.</p>

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.

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.

Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review

2014 ◽  
Vol 40 (5) ◽  
pp. 450-457 ◽  
Author(s):  
B. M. Saltzman ◽  
J. M. Frank ◽  
W. Slikker ◽  
J. J. Fernandez ◽  
M. S. Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grip Strength ◽  
Complication Rate ◽  
Contralateral Side ◽  
Wrist Flexion ◽  
Proximal Row Carpectomy ◽  
Non Union ◽  
Radial Deviation ◽  
Hand Grip ◽  
Flexion Extension

We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I–III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate. Level of evidence: Level III (Level I-III studies), Systematic Review. Therapeutic.

scholarly journals Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

2019 ◽  
Vol 08 (04) ◽  
pp. 264-267 ◽  
Author(s):  
J. C. Botelheiro ◽  
Silvia Silverio ◽  
Ana Luísa Neto
Keyword(s):  
The Other ◽  
Stage Iiib ◽  
X Rays ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
The Past ◽  
Shortening Osteotomy ◽  
Flexion Extension ◽  
Kienbock’S Disease

Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion–extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock’s disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.

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