Force distribution through the wrist joint in patients with different stages of Kienböck's disease: Using computed tomography osteoabsorptiometry

2000 ◽  
Vol 25 (5) ◽  
pp. 870-876 ◽  
Author(s):  
Norimasa Iwasaki ◽  
Akio Minami ◽  
Takeshi Miyazawa ◽  
Kiyoshi Kaneda
Keyword(s):  
Computed Tomography ◽  
Wrist Joint ◽  
Force Distribution ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

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.

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.

Microstructural study of the lunate in stage III Kienböck’s disease with micro-computed tomography imaging

2016 ◽  
Vol 42 (1) ◽  
pp. 71-77 ◽  
Author(s):  
G. Xiong ◽  
Z. Xiao ◽  
H. Wang ◽  
S. Guo ◽  
J. Tao
Keyword(s):  
Computed Tomography ◽  
Trabecular Bone ◽  
Bone Structure ◽  
Stage Iii ◽  
Micro Computed Tomography ◽  
Secondary Fracture ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Eventual Collapse ◽  
Kienbock’S Disease

Seventeen fresh lunates with stage III Kienböck’s disease were scanned with micro-computed tomography. Four regions of interest were selected to measure trabecular parameters, which were compared with those from normal lunates. Within the three regions in the distal surface, there was more compact trabecular bone in the middle region when compared with the palmar and dorsal regions. In the central part, the trabeculae of the Kienböck’s lunates were much thicker than those in normal lunates. The diameters of the palmar nutrient foramina of the Kienböck’s lunates were significantly smaller than those in normal lunates. In affected lunates, the bony disruptions were mostly located in the palmar or dorsal areas, which were shown from trabecular bone structure analysis to be structurally weaker. This leads to separation of the distal part of the fractured bone, disruption of the blood supply, poor bone remodelling and proneness to secondary fracture and eventual collapse.

Kinematics of the wrist in Kienböck’s disease: a four-dimensional computed tomography study

2021 ◽  
pp. 175319342098779
Author(s):  
Simon B. M. MacLean ◽  
Gregory I. Bain
Keyword(s):  
Computed Tomography ◽  
Ct Scanning ◽  
Ulnar Styloid ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Internal Instability ◽  
Fracture Types ◽  
Midcarpal Joint ◽  
Kienbock’S Disease

We studied the kinematics of 20 wrists affected by Kienböck’s disease using four-dimensional computed tomography (4-D-CT) scanning. Degenerative changes progressed from the lunate facet to the scaphoid fossa at the radiocarpal articulation, then involved the midcarpal joint. Lunate fracture types included coronal (14/20), sagittal (10/20) and ligament attachment-types (8/20). Findings specific to dynamic scanning included the nutcracker phenomenon (12/20), anterior radiolunate impingement (7/20), internal instability of the lunate (6/20), ulnar styloid triquetral impingement (3/20) and dynamic proximal row instability (2/20). Ulnocarpal translocation was found in 4/20 cases. Dynamic 4-D-CT has helped us to identify a subset of pathology in Kienböck’s disease on assessment of static imaging. Better understanding of these phenomena can improve our understanding of symptoms and may help direct surgical treatment. Level of evidence: IV

Comparison of Biomechanical Results about the Effect of Three Surgery Methods in Decompression of Lunate Bone

2021 ◽  
Author(s):  
Hamid Namazi ◽  
Ebrahim Ghaedi ◽  
Mohammad T. Karimi
Keyword(s):  
Principal Stress ◽  
Surgical Procedures ◽  
Wrist Joint ◽  
Von Mises Stress ◽  
Main Question ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Wrist Function ◽  
Kienbock’S Disease

Abstract Objective Kienbock's disease is an unusual disorder caused by osteonecrosis and the collapse of lunate bone which leads to pain and a chronic decrease in wrist function. The treatments in this disease aim to relieve pain and maintain wrist function and movement. Various surgical procedures have been recommended for the subjects with Kienbock's disease; however, the main question posed here is which of the selected procedures are more successful in relief of the pressure applied on lunate. Methods and Materials Computed tomography (CT) scan images of a normal subject were used to create a three-dimensional model of the wrist joint. The effects of several surgical procedures, including radial shortening, capitate shortening, and a combination of both radial and capitate shortening, on the joint contact force of the wrist bones were investigated. Results The pressure applied to the lunate bone in articulation with radius, scaphoid, capitate, hamate, and triquetrum varied between 19.7 and 45.4 MPa. The Von Mises stress, maximum principal stress, and minimum principal stress decreased in the model with a combination of radius and capitate shortening. Conclusion It can be concluded from the results of this study that the combinations of radius and capitate shortening seem to be an effective procedure to decrease joint pressure, if the combined surgery could not be done, shortening of radius or capitate would be recommended. Level of Evidence This is a Level III study.

Force transmission through the wrist joint in Kienböck's disease: A two-dimensional theoretical study

1998 ◽  
Vol 23 (3) ◽  
pp. 415-424 ◽  
Author(s):  
Norimasa Iwasaki ◽  
Eiichi Genda ◽  
Akio Minami ◽  
Kiyoshi Kaneda ◽  
Edmund Y.S. Chao
Keyword(s):  
Theoretical Study ◽  
Wrist Joint ◽  
Two Dimensional ◽  
Force Transmission ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

RELIABILITY OF LICHTMAN'S CLASSIFICATION FOR KIENBÖCK'S DISEASE IN 99 SUBJECTS

Hand Surgery ◽  
2011 ◽  
Vol 16 (01) ◽  
pp. 15-18 ◽  
Author(s):  
Masaki Shin ◽  
Masahiro Tatebe ◽  
Hitoshi Hirata ◽  
Shukuki Koh ◽  
Takaaki Shinohara
Keyword(s):  
Classification System ◽  
Wrist Joint ◽  
Interobserver Reliability ◽  
Clinical Settings ◽  
X Rays ◽  
New Classification ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease. Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study. Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228). Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

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.

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.

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