Microstructural study of the lunate in stage III Kienböck’s disease with micro-computed tomography imaging

2016 ◽  
Vol 42 (1) ◽  
pp. 71-77 ◽  
Author(s):  
G. Xiong ◽  
Z. Xiao ◽  
H. Wang ◽  
S. Guo ◽  
J. Tao
Keyword(s):  
Computed Tomography ◽  
Trabecular Bone ◽  
Bone Structure ◽  
Stage Iii ◽  
Micro Computed Tomography ◽  
Secondary Fracture ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Eventual Collapse ◽  
Kienbock’S Disease

Seventeen fresh lunates with stage III Kienböck’s disease were scanned with micro-computed tomography. Four regions of interest were selected to measure trabecular parameters, which were compared with those from normal lunates. Within the three regions in the distal surface, there was more compact trabecular bone in the middle region when compared with the palmar and dorsal regions. In the central part, the trabeculae of the Kienböck’s lunates were much thicker than those in normal lunates. The diameters of the palmar nutrient foramina of the Kienböck’s lunates were significantly smaller than those in normal lunates. In affected lunates, the bony disruptions were mostly located in the palmar or dorsal areas, which were shown from trabecular bone structure analysis to be structurally weaker. This leads to separation of the distal part of the fractured bone, disruption of the blood supply, poor bone remodelling and proneness to secondary fracture and eventual collapse.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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.</p>

scholarly journals The outcome of treatment of Kienbock's disease stage III by excisional arthroplasty and palmaris longus spacer

2021 ◽  
Vol 2 (2) ◽  
pp. 158-166
Author(s):  
Al Bayati MA ◽  
Muttar AY ◽  
Al-Khishali TJ ◽  
Al Bayati MM ◽  
Hameed BM
Keyword(s):  
Case Series ◽  
Hospital Environment ◽  
Stage Iii ◽  
Disease Stage ◽  
Dash Score ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Palmaris Longus ◽  
Kienbock’S Disease

Purpose: To present the outcomes of treatment of Kienbock's Disease (KD) stage III, by excisional arthroplasty of lunate with Palmaris Longus (PL) tendon as a spacer. Methods: Twenty-one patients were diagnosed with KD stage III, 14 females, and 7 males. They were treated by excision of the lunate plus PL tendon ball as a spacer. Mean follow up period was 38 months (24-60). Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging (plain and CT scan), MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system. Results: Nineteen patients improved clinically to a great extent, by relieving symptoms, a better range of movement, functional satisfaction and no conspicuous Carpal Height Ratio (CHR) change. Mean DASH score improved from 38.5 to 6.8. Two patients had less favorable clinical outcome, yet, they were not interested to have further operations. Conclusions: Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures. Type of study/Level of evidence: Prospective case series, level IV.

Kinematics of the wrist in Kienböck’s disease: a four-dimensional computed tomography study

2021 ◽  
pp. 175319342098779
Author(s):  
Simon B. M. MacLean ◽  
Gregory I. Bain
Keyword(s):  
Computed Tomography ◽  
Ct Scanning ◽  
Ulnar Styloid ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Internal Instability ◽  
Fracture Types ◽  
Midcarpal Joint ◽  
Kienbock’S Disease

We studied the kinematics of 20 wrists affected by Kienböck’s disease using four-dimensional computed tomography (4-D-CT) scanning. Degenerative changes progressed from the lunate facet to the scaphoid fossa at the radiocarpal articulation, then involved the midcarpal joint. Lunate fracture types included coronal (14/20), sagittal (10/20) and ligament attachment-types (8/20). Findings specific to dynamic scanning included the nutcracker phenomenon (12/20), anterior radiolunate impingement (7/20), internal instability of the lunate (6/20), ulnar styloid triquetral impingement (3/20) and dynamic proximal row instability (2/20). Ulnocarpal translocation was found in 4/20 cases. Dynamic 4-D-CT has helped us to identify a subset of pathology in Kienböck’s disease on assessment of static imaging. Better understanding of these phenomena can improve our understanding of symptoms and may help direct surgical treatment. Level of evidence: IV

Capitate osteotomy and transposition for type III Kienböck’s disease

2018 ◽  
Vol 43 (7) ◽  
pp. 708-711 ◽  
Author(s):  
Jianbing Li ◽  
Zhijun Pan ◽  
Yunzhen Zhao ◽  
Xinlei Hu ◽  
Xiang Zhao
Keyword(s):  
Stage Iii ◽  
Level Of Evidence ◽  
Unaffected Side ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Iliac Bone Graft ◽  
The Mean ◽  
The One ◽  
Autologous Iliac Bone Graft ◽  
Kienbock’S Disease

The aim of this study was to assess the results of capitate osteotomy and transposition for stage III Kienböck’s disease. Capitate osteotomy and transposition combined with an autologous iliac bone graft was carried out in 17 patients. At the final follow-up for a mean of 68 months (range 16–127 months) after surgery, the mean visual analogue scale score was 0.6 (range 0–5). The mean Wrightington wrist function score was 8. The mean grip strength was 79% of the unaffected side. There were 16 satisfactory results. The one unsatisfactory result occurred in a woman who developed a nonunion of the osteotomy. There were no other complications of the surgery. Our results show that capitate osteotomy and transposition is a simple and reliable method for the management of stage III Kienböck’s disease. Level of evidence: IV

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