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.

History Page: Leaders in MSK Radiology

2021 ◽  
Vol 25 (02) ◽  
pp. 274-276
Author(s):  
Franz Kainberger ◽  
Daniela Hahn
Keyword(s):  
Radiation Oncology ◽  
Scientific Work ◽  
X Rays ◽  
Radiographic Images ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

AbstractRobert Kienböck (1871–1953) may be regarded as one of the first musculoskeletal radiologists who began his clinical and scientific work 2 years after the discovery of X-rays. He lent his name to Kienböck's disease, a traumatic malacia and osteonecrosis of the lunate, and to several other eponyms of diseases, devices, and parameters in radiology and radiation oncology. With his meticulous analysis of radiographic images of the highest quality, he anticipated many theories that were proposed in later decades.

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.

Ulnar Variance in Kienböck’s Disease

1986 ◽  
Vol 11 (2) ◽  
pp. 258-260
Author(s):  
S. S. KRISTENSEN ◽  
E. THOMASSEN ◽  
F. CHRISTENSEN
Keyword(s):  
Bone Formation ◽  
Mean Value ◽  
Observation Time ◽  
Ulnar Variance ◽  
X Rays ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
The Mean ◽  
Kienbock’S Disease

Forty four patients with forty seven wrists suffering from Kienböck’s disease were re-examined. The mean observation time was 20.5 years. In all forty seven wrists the treatment had been immobilization. Using a standard X-ray projection, and a reliable method of ulnar variance measuring, the ulnar variance was determined by three observers independently. Comparing the result with the ulnar variance in normal wrists we found the so-called “ulnar minus variant” overrepresented in patients with Kienböck’s disease. However, comparing X-rays taken at the time of diagnosis with X-rays at re-examination, we found in eight out of forty seven wrists that a subchondral bone formation in the distal radius opposite the lunate bone had taken place. This bone formation will tend to enhance the negative value of ulnar variance measurements, and suggests an explanation of the overrepresentation of “ulnar minus variants” in Kienböck’s disease. Excluding these eight wrists from the material and comparing the mean ulnar variance value in the remaining thirty nine wrists with the mean value in normal wrists no statistical difference was shown. Based on these observations it seems unlikely that the “ulnar minus variant” has any bearing on the cause of Kienböck’s disease.

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

2019 ◽  
Vol 08 (04) ◽  
pp. 264-267 ◽  
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.

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.

Kienböck’s Disease — Late Results by Non-Surgical Treatment

1986 ◽  
Vol 11 (3) ◽  
pp. 422-425
Author(s):  
S. S. KRISTENSEN ◽  
E. THOMASSEN ◽  
F. CHRISTENSEN
Keyword(s):  
Treated Group ◽  
Late Results ◽  
X Rays ◽  
Efficient Treatment ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Surgical Methods ◽  
Radiocarpal Joint ◽  
Kienbock’S Disease

Two groups of patients with Kienböck’s disease were followed. Twenty-three wrists had been immobilised with plaster and twenty-six had no treatment. At follow up there was a marked improvement in both groups. Eighty-three percent of the wrists in the new treated group were pain free, or reported pain only on heavy work, and in the nontreated group this was valid for 77%. Examining X-rays at follow up we did not find a single wrist in which the lunate was normal or less deformed than at the time of diagnosis. In all forty-nine wrists the lunate was deformed and in 67% osteoarthrosis in the radiocarpal joint was evident. It is concluded, that Kienböck’s disease has a naturally benign course, the remaining symptoms at follow-up might be caused by osteoarthrosis and nothing seems to be gained by rigorous immobilisation. If pain persists efficient treatment must be based on surgical methods.

scholarly journals ARTHROSCOPIC ASSESSMENT OF THE WRIST WITH KIENBÖCK’S DISEASE

2018 ◽  
Vol 26 (5) ◽  
pp. 286-289
Author(s):  
Guilherme Augusto Silva Amariz ◽  
Maria Virginia Arranz Abreu ◽  
Bruno Azevedo Veronesi ◽  
Marcelo Rosa de Rezende
Keyword(s):  
Carpal Bones ◽  
Wrist Arthroscopy ◽  
X Rays ◽  
Level Of Evidence ◽  
Surgical Decision ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Surgical Decision Making ◽  
Lunate Necrosis ◽  
Kienbock’S Disease

ABSTRACT Objective: Treatment of Kienböck's disease is challenging and the variability of results, despite the surgical technique, shows that there must be other aspects that can influence outcomes. The objective of this study is determine, through arthroscopic approach, the pattern of impairment of the carpal bones in Lichtman stage III patients. Method: Wrist arthroscopy was performed in patients with symptoms and evidence of lunate necrosis on x-rays, with signs of 3A and 3B stages. The Outerbridge classification was used to grade the articular status of the carpal bones. Results: Fifteen patients with stage 3 disease were assessed, five of whom were staged as type 3A and ten as 3B using the Lichtman stages. According to the Outerbridge classification, the lunate sulcus was the most affected with means of 2.8 at 3A and 2.9 at 3B. Other areas were significantly less affected with means of 1.1 and 1.3, respectively. Conclusion: Arthroscopic assessment of the wrist could aid in surgical decision making, offering more details on cartilage status in stage 3 Kienböck's disease. Level of Evidence III, Study of nonconsecutive patients, without consistently applied reference “gold” standard.

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.

The classification and treatment of Kienböck’s disease: the state of the art and a look at the future

2010 ◽  
Vol 35 (7) ◽  
pp. 549-554 ◽  
Author(s):  
D. M. Lichtman ◽  
N. E. Lesley ◽  
S. P. Simmons
Keyword(s):  
Classification System ◽  
Treatment Algorithm ◽  
Current Treatment ◽  
Classification Systems ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Appropriate Treatment ◽  
Slow Progression ◽  
Eventual Collapse ◽  
Kienbock’S Disease

The proper treatment of Kienböck’s disease, a disorder that displays slow progression with eventual collapse of the lunate and alteration of the surrounding carpal architecture, requires an understanding of its aetiology and natural history. A reproducible classification system assists the surgeon in making appropriate treatment choices. In this discussion, we review the history and rationale for the four-stage step-wise classification system, along with our current treatment algorithm. We also discuss emerging classification systems and speculate on future directions in treatment and research.

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