Existing or Worsening Symptoms of Kienböck’s Disease after Distal Radius Fracture: Two Case Reports

2018 ◽  
Vol 23 (04) ◽  
pp. 585-588
Author(s):  
Takeshi Ogawa ◽  
Shunsuke Asakawa
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Reports ◽  
Combined Therapy ◽  
Compression Fracture ◽  
Radius Fracture ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

We report two rare cases of existing or worsening symptoms due to Kienböck’s disease after distal radius fracture (DRF). During examination, radiographs show changes in the lunate bone; there was persistent wrist pain after treatment for DRF. In each case, surgeries were performed: A combined therapy (bone marrow transfusion, bone peg graft, external fixation, and low intensity pulsed ultrasound) for one, as well as carpal coalition for another. The etiology of these case presentations suggest that a compression fracture of the lunate due to a DRF resulted in softening and sclerosis.

Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis

2019 ◽  
Vol 24 (03) ◽  
pp. 276-282
Author(s):  
Christoph U. Schulz
Keyword(s):  
Distal Radius ◽  
Core Decompression ◽  
Stage I ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Mayo Wrist Score ◽  
Lunate Necrosis ◽  
Kienbock’S Disease

Background: Metaphyseal core decompression of the distal radius (MCD) is clinically effective in early lunate necrosis without changing individual wrist mechanics. Its concept is based on the induction of physiologic mechanisms known as physiologic fracture healing response. However, this biological concept does not yet have its place in the historically developed mechanical concepts about Kienböck’s disease and requires more detailed clarifications to understand when a change of individual wrist mechanics might be unnecessary. Methods: Thirteen consecutive cases, Lichtman stage I (n = 1) or II (n = 12), confirmed by conventional MRI, were treated by MCD. Time off work, changes in magnetic resonance imaging of the lunate, as well as clinical outcome using modified Mayo wrist score were evaluated at final follow-up. Results: Return to work was at six (1–10) weeks after surgery. MRI controls at short-term generally demonstrated stop of progression and signs of bone healing. Independently from ulna variance complete signal normalization was observed in six and a distinct, yet incomplete decrease of lunate bone marrow edema and zones of fat necrosis was confirmed in further six cases after a mean of 21 (13–51) weeks. One patient had radiographic controls only, stating normal healing at 56 months. After a mean follow-up of 37 (12–70) months the clinical outcomes were excellent in eleven and good in two cases (mean 95% in modified Mayo wrist score). Conclusions: In stage I and II lunate necrosis MCD stops disease progression, it improves clinical symptoms and induces normalization of lunate bone signal alterations in MRI. Findings suggest that stage I and II lunate necrosis can be effectively treated without alterations of individual wrist mechanics. Future studies are necessary to readjust common concepts regarding Kienböck’s disease, especially focusing on conservative therapy.

THE ETIOLOGY OF KIENBÖCK'S DISEASE — A HISTOPATHOLOGICAL STUDY

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 63-69 ◽  
Author(s):  
H.-G. Simank ◽  
M. Schiltenwolf ◽  
W. Krempien
Keyword(s):  
Femoral Head ◽  
Blood Supply ◽  
Primary Lesion ◽  
Histopathological Study ◽  
Arterial Blood Supply ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Arterial Blood ◽  
Kienbock’S Disease

The etiology of the necrosis of the lunate bone is still unclear. In today's theories, the necrosis is explained by impairment of the arterial bone circulation or fracture following mechanical overloading. In this study, six specimen in different stages of the disease were investigated histologically. In all the specimens, focal necrosis was detected, but also signs of regeneration, i.e. immature bone formation. No signs of fracture were seen in all stages of the disease. These findings are not compatible with sudden interruption of arterial blood supply or fracture of the lunate bone as a primary lesion. Comparable histological patterns are known in the necrosis of the femoral head. The etiological model of necrosis of the femoral head is well investigated and postulates primary marrow hypertension, induced by impairment of the venous drainage. Our results are contradictory to the etiological theories of fracture or breakdown of the arterial blood supply as a primary lesion in Kienböck's disease, and support the assumption that the model of intraosseous hypertension is transferable to the necrosis of the lunate bone.

scholarly journals 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.]

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

<p><strong>Introducción</strong></p><p><strong></strong>El 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.<strong> </strong></p><p><strong>Materiales y Métodos</strong></p><p><strong></strong>Este 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).</p><p><strong>Resultados</strong></p><p><strong></strong>El seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II.<strong> </strong>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.<strong> </strong></p><p><strong>Conclusión</strong></p><p><strong></strong>La descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck.</p>

scholarly journals Volar Distal Radioulnar Joint Dislocation Associated with Acute Median Nerve Neuropathy and a Distal Radius Fracture

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Naser Alnusif ◽  
Sultan Aldebeyan ◽  
Rudolf Reindl
Keyword(s):  
Median Nerve ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Rare Case ◽  
Case Reports ◽  
Carpal Tunnel Release ◽  
Distal Radioulnar Joint ◽  
Radius Fracture ◽  
Radioulnar Joint ◽  
Median Nerve Neuropathy

Volar distal radioulnar (DRUJ) dislocations are uncommon and can easily be missed. We present a rare case of an irreducible volar DRUJ dislocation associated with a distal radius fracture and acute median nerve neuropathy at the wrist. An attempt to reduce the DRUJ dislocation in the emergency department had failed. The patient was then taken to the operating room requiring a carpal tunnel release, as well as an open reduction and internal fixation of the distal radius fracture and repair of the volar distal radioulnar ligament. We also review some of the volar DRUJ case reports in the literature.

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.

Histopathology of Kienböck’s Disease

1996 ◽  
Vol 21 (1) ◽  
pp. 89-93 ◽  
Author(s):  
H. HASHIZUME ◽  
H. ASAHARA ◽  
K. NISHIDA ◽  
H. INOUE ◽  
T. KONISHIIKE
Keyword(s):  
Early Stage ◽  
Granulation Tissue Formation ◽  
Bone Necrosis ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Reactive Interface ◽  
Histopathological Studies ◽  
Kienbock’S Disease

Histopathological studies of extracted whole lunate bones obtained from 10 patients with Stage 3 Kienböck’s disease at surgery for tendon-ball replacement were correlated with magnetic resonance imaging (MRI), computed tomography (CT) and tomography images made prior to surgery. A reforming zone, or a reactive interface between the reactive new bone and granulation tissue formation, and new vascularization were observed surrounding the bone necrosis area showing empty lacunae, fatty necrosis, and disappearance of osteoid. Findings of CT, tomography and microradiography of slices of extracted lunate bone confirmed that fractures of the articular cartilage and the subchondral bone occurred secondarily by overloading, and showed the extent of the collapsed area of the lunate. MRI showed complete loss of signal intensity in T1 images of the lesion of the lunate in advanced Stage 3 Kienböck’s disease. MRI is at present unable to distinguish bone necrosis, the histological reactive interface or surrounding hyperaemia in detail. However, the low-intensity arc, or the reactive interface present on MRI in early Stage 3, sometimes correlates with the histological findings of osteoid and granulation zones.

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