Results of Capito-hamate Lengthening Osteotomy Fixed with Herbert Screw to Compensate for Decreased Carpal Height in Advanced Kienböck's Disease

2010 ◽  
Vol 35 (10) ◽  
pp. 17
Author(s):  
Muhammad A. Quolquela
Keyword(s):  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Herbert Screw ◽  
Lengthening Osteotomy ◽  
Carpal Height ◽  
Kienbock’S Disease

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.

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.

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.

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.

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 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.

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.

scholarly journals Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis

2020 ◽  
Vol 09 (05) ◽  
pp. 404-410
Author(s):  
Nikhil Goyal ◽  
Vivek Singh ◽  
Sitanshu Barik ◽  
Santosh Behera
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Level Of Evidence ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Vas Score ◽  
Early Results ◽  
Carpal Height ◽  
Kienbock’S Disease

Abstract Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.

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