scholarly journals Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review

2020 ◽  
Vol 9 (06) ◽  
pp. 535-548
Author(s):  
Patrick Q. Wang ◽  
Bogdan A. Matache ◽  
Ruby Grewal ◽  
Nina Suh
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Proximal Row Carpectomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease ◽  
All Treatment

Abstract Background Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. Purpose This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. Methods A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. Results A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. Conclusion In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.

scholarly journals Systematic review of Surgical Management of Early Stages of Kienböck’s Disease

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A K H Abouelela ◽  
A Nabil ◽  
M A Lami
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Range Of Motion ◽  
Core Decompression ◽  
Vascularized Bone Graft ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Abstract Background Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft. Objective To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease. Methodology The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications. Results This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score. Conclusion Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.

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.

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.

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.

scholarly journals Update on the Use of Arthroscopy in Kienböck's Disease Management

2020 ◽  
Vol 48 (02) ◽  
pp. 119-127
Author(s):  
René Jorquera Aguilera ◽  
Camila Azócar Sanhueza
Keyword(s):  
Quality Of Life ◽  
Disease Management ◽  
Surgical Technique ◽  
Functional Outcomes ◽  
Treatment Algorithm ◽  
Review Of The Literature ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

AbstractKienböck's disease is a clinical-radiological condition that can permanently affect wrist functionality and the patient's quality of life. Proper, pertinent diagnosis and treatment are required to avoid salvage procedures. Arthroscopic techniques have emerged as an important tool for the treatment of certain stages of the disease.We present a review of the literature and propose a treatment algorithm according to the stage of the disease, including arthroscopic techniques. We detail the surgical technique of arthroscopic scaphocapitate arthrodesis, and the functional outcomes obtained by our group.

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.

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