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

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.

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

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80087-9 ◽

1998 ◽

Vol 23 (6) ◽

pp. 741-745 ◽

Cited By ~ 62

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.

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

Journal of Wrist Surgery ◽

10.1055/s-0039-1688947 ◽

2019 ◽

Vol 08 (04) ◽

pp. 264-267 ◽

Cited By ~ 1

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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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.]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

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

IntroducciónEl 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. Materiales y MétodosEste 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).ResultadosEl seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II. 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. ConclusiónLa descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck.

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A Comparison of Conservative Treatment and Silicone Replacement Arthroplasty in Kienböck’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90026-4 ◽

1986 ◽

Vol 11 (1) ◽

pp. 98-102

Author(s):

G. EVANS ◽

F. D. BURKE ◽

N. J. BARTON

Keyword(s):

Conservative Treatment ◽

Cyst Formation ◽

Clinical Results ◽

Degenerative Changes ◽

Carpal Collapse ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Replacement Arthroplasty ◽

Kienbock’S Disease

Two forms of treatment of Kienböck’s disease were compared in a total of thirty-seven wrists. Sixteen had been treated conservatively and were followed-up for an average of twenty years. Twenty-one had undergone silicone replacement arthroplasty an average of five years prior to review. Clinical results of conservative treatment showed four (25%) good, six (37.5%) fair and six (37.5%) with a poor result. Radiological deterioration was seen in only a quarter of cases. After silicone replacement there were nine (43%) good and seven (33%) fair. Five (24%) cases had a very poor result associated with dislocation of the prosthesis but design improvements have made this less frequent. Radiological abnormalities were noted in more than half of cases treated by silicone replacement arthroplasty. These included carpal collapse, scapho-lunate diastasis and generalised degenerative changes in the carpus. There were two cases with cyst formation in the capitate which closely resembled previous reports of silicone synovitis.

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Radiologic Guide to Surgical Treatment of Kienbock’s Disease

Current Problems in Diagnostic Radiology ◽

10.1067/j.cpradiol.2017.04.012 ◽

2018 ◽

Vol 47 (2) ◽

pp. 103-109 ◽

Cited By ~ 3

Author(s):

Erika M. Nealey ◽

Jonelle M. Petscavage-Thomas ◽

Felix S. Chew ◽

Christopher H. Allan ◽

Alice S. Ha

Keyword(s):

Surgical Treatment ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

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Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienböck's disease

Chirurgie de la Main ◽

10.1016/s1297-3203(00)73484-6 ◽

2000 ◽

Vol 19 (4) ◽

pp. 223-231 ◽

Cited By ~ 55

Author(s):

M. Sauerbier ◽

S. Kluge ◽

B. Bickert ◽

G. Germann

Keyword(s):

Wrist Arthrodesis ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Objective Outcomes ◽

Kienbock’S Disease

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194810 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Stage 3 KienbÖck’s Disease: Reconstruction of the Fractured Lunate using a Free Vascularized Iliac Bone Graft and External Fixation

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0766 ◽

2002 ◽

Vol 27 (4) ◽

pp. 369-373 ◽

Cited By ~ 28

Author(s):

M. GABL ◽

M. LUTZ ◽

Cl. REINHART ◽

R. ZIMMERMANN ◽

S. PECHLANER ◽

...

Keyword(s):

Clinical Outcome ◽

Necrotic Core ◽

Iliac Bone ◽

The Other ◽

Carpal Collapse ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Iliac Bone Graft ◽

Kienbock’S Disease

Eighteen patients with stage 3 Kienböck’s disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.

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