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 Bilateral Kienböck’s disease concomitant with gouty arthritis

2020 ◽  
Vol 13 (3) ◽  
pp. e233725
Author(s):  
Deepak Chouhan ◽  
Vivek Shankar ◽  
Mohammed Tahir Ansari
Keyword(s):  
Gouty Arthritis ◽  
Left Wrist ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Daily Life Activities ◽  
History Of ◽  
Laboratory Investigations ◽  
History Of Pain ◽  
The Right ◽  
Kienbock’S Disease

A 38-year-old man presented with a 2-month history of pain and stiffness in the bilateral wrist. The pain in right wrist was disabling and severe enough to restrict the daily life activities. After the evaluation of clinical and radiological features, the patient was diagnosed with Kienböck’s disease Lichtman stage IIIB in the right wrist and stage IIIA in the left wrist. Routine laboratory investigations revealed a serum uric acid 9.27 mg/dL. Lunate excision and scaphocapitate fusion were done in the right wrist after discussing with the patient. The histopathological examinations of tophi in synovial tissue were negatively birefringent under polarised light microscopy. It confirmed the diagnoses of gout. Febuxostat was started postoperatively. The patient returned to work at the end of 5 months. There was no recurrence of symptoms and radiological signs of arthritis at the end of 1 year.

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.

Long-term outcome (22–36 years) of silicone lunate arthroplasty for Kienböck’s disease

2013 ◽  
Vol 39 (4) ◽  
pp. 405-415 ◽  
Author(s):  
T. Viljakka ◽  
K. Tallroth ◽  
M. Vastamäki
Keyword(s):  
Range Of Motion ◽  
Functional Results ◽  
Cyst Formation ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

Silicone lunate arthroplasty for Kienböck’s disease was abandoned several years ago due to severe silicone cyst formation. We identified 53 patients and retrospectively evaluated short-term radiological and clinical results, as well as long-term radiological outcome, pain relief, range of motion, strength, and functional results, a mean 27 years after surgery. The incidence of silicone cysts was 78%. Twelve implants were removed — three due to implant dislocation and nine due to silicone synovitis — and six wrist joints were fused. Pain on the visual analogue scale averaged 2.2 at rest and 5.4 during heavy exertion. Range of motion of those wrists not fused reached 65% of that of the contralateral wrist, and strength of all wrists reached 72%. Those few patients who developed no silicone cysts by 10 years post-operatively will not form cysts and will retain their satisfactory clinical, functional, and radiological result. These very long-term results confirm that silicone lunate arthroplasty should not be used for Kienböck’s disease.

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.

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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