A novel nickel–titanium memory alloy arthrodesis concentrator for the treatment of stage IIIb aseptic lunate necrosis (Kienböck’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.

Download Full-text

Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienböck's disease

Acta Orthopaedica et Traumatologica Turcica ◽

10.1016/j.aott.2018.02.004 ◽

2018 ◽

Vol 52 (3) ◽

pp. 211-215 ◽

Cited By ~ 2

Author(s):

Mesut Tahta ◽

Cem Ozcan ◽

Gurkan Yildiz ◽

Izge Gunal ◽

Muhittin Sener

Keyword(s):

Stage Iiib ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

Download Full-text

ARTHROSCOPIC ASSESSMENT OF THE WRIST WITH KIENBÖCK’S DISEASE

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182605208269 ◽

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.

Download Full-text

Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500346 ◽

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.

Download Full-text