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.

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>

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.

Core Decompression of the Distal Radius for the Treatment of Kienböck's Disease: A Biomechanical Study

2008 ◽  
Vol 33 (9) ◽  
pp. 1478-1481 ◽  
Author(s):  
Gary M. Sherman ◽  
Catherine Spath ◽  
Brian J. Harley ◽  
Marsha M. Weiner ◽  
Frederick W. Werner ◽  
...  
Keyword(s):  
Distal Radius ◽  
Core Decompression ◽  
Biomechanical Study ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

Very Distal Radius Wedge Osteotomy for Kienböck’s Disease: Case Series

2017 ◽  
Vol 22 (04) ◽  
pp. 490-496 ◽  
Author(s):  
Hirotaka Okubo ◽  
Chojo Futenma ◽  
Hideyuki Sunagawa ◽  
Masaki Kinjo ◽  
Fuminori Kanaya
Keyword(s):  
Distal Radius ◽  
Stage Iii ◽  
Wedge Osteotomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Disease Case ◽  
Kienbock’S Disease

Background: Radius osteotomy is one of the standard surgical procedures for the treatment of Kienböck’s disease. Unfortunately, radius osteotomy can result in an incongruous distal radio-ulnar joint (DRUj) postoperatively, because the procedure is performed proximal to the DRUj. Methods: A very distal radius wedge osteotomy was performed as a 15-degree lateral closing wedge osteotomy with the apex of the wedge distal to that of conventional lateral closing wedge osteotomy; this procedure was developed to avoid postoperative incongruous DRUj. We performed this procedure on 6 patients (stage III-A: 1, stage III-B: 5) with a mean age of 49 years. Clinical and radiographic evaluations were performed at a mean follow-up of 32 months. Results: Wrist pain disappeared in all patients. Mean grip strength improved from 35% to 87% of the contralateral side (p = 0.0255). Mean range of motion, measured as flexion-extension arc, improved from 93 to 128 degrees. Nakamura’s score was good in all patient. Mean lunate covering ratio increased from 61% to 90% (p = 0.0151) and mean sigmoid notch inclination angle, a radiographic parameter of DRUj congruency, was not significantly different between pre-operative and final follow-up evaluation. No clinical or radiographic DRUj osteoarthritis findings were observed. Conclusions: Our procedure of very distal radius wedge osteotomy provided satisfactory clinical results without an incongruous DRUj. This technique might prevent the occurrence of postoperative DRUj osteoarthritis.

The Effects of Radial Core Decompression on Lunate Kinematics

2010 ◽  
Author(s):  
Andrew Smith ◽  
Philip Nowicki ◽  
Mohamed Samir Hefzy ◽  
Michael Dennis ◽  
Abdul Azim Mustapha
Keyword(s):  
Early Stage ◽  
Core Decompression ◽  
Lunate Bone ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Treatment Techniques ◽  
Compressive Loads ◽  
Forearm Bones ◽  
Ulnar Lengthening ◽  
Kienbock’S Disease

Kienbock’s disease is an avascular necrosis of the lunate bone in the wrist [1]. Current early-stage treatment techniques include joint leveling procedures, such as radial shortening and ulnar lengthening. These techniques serve to unload the radiolunate joint and redistribute compressive loads to the radioscaphoid joint [2]. Additionally, core decompression of the distal radius and ulna, first introduced by Illarramendi [3], and has been found clinically effective in improving early stage Kienbock’s disease. Clinical studies have since found radial core decompression (RCD) to be as effective as performing the procedure on both forearm bones [4]. However, there have been no biomechanical studies characterizing the changes in wrist kinematics following a RCD. The purpose of this study is to determine the changes in lunate motions following a RCD.

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.

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

2021 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Necmettin Turgut ◽  
Okyar Altas ◽  
Hayati Durmaz
Keyword(s):  
Grip Strength ◽  
Dash Score ◽  
Arthroscopic Debridement ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Hand Grip ◽  
Case Series Study ◽  
The Mean ◽  
Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

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