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

scholarly journals Wrist Swelling in Kienböck's Disease

2018 ◽  
Vol 07 (05) ◽  
pp. 389-393
Author(s):  
Hirofusa Ichinose ◽  
Etsuhiro Nakao ◽  
Takaaki Shinohara ◽  
Masahiro Tatebe ◽  
Harumoto Yamada ◽  
...  
Keyword(s):  
Histological Examination ◽  
Resonance Imaging ◽  
Synovial Proliferation ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Capsular Ligament ◽  
Kienböck's Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Common Manifestation ◽  
Kienbock’S Disease

Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.

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.

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.

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.

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

The 100 Top-Cited Articles about Kienböck’s Disease: A Bibliometric Analysis

2020 ◽  
Author(s):  
Ahmadreza Afshar ◽  
Ali Tabrizi
Keyword(s):  
Geographic Origin ◽  
Hand Surgery ◽  
The United States ◽  
Absolute Number ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Level Ii ◽  
Number Of Citations ◽  
Kienbock’S Disease

Abstract Introduction The aim of this study was to analyze the 100 top-cited articles about Kienböck’s disease and their features. Materials and Methods A search through the Elsevier, Scopus database journal articles about Kienböck’s disease yielded 1,025 results. The 100 top-cited articles were identified and filtered again to exclude self-citations. The 100 top-cited articles without self-citations were analyzed for the number of citation, citation density, publishing journal, language, authorship, and geographic origin. The abstracts of the articles were obtained to review and determine the types of articles and levels of evidence. Results The mean of the 100 top-cited articles’ absolute number of citations was 63.3 ± 34 (range: 23–199). Citation densities ranged from 1 to 8. A total of 97 (97%) articles were written in English. The leading countries were the United States with 50 (50%) articles followed by Japan with 16 (16%) articles. Forty (40%) articles have been published in the Journal of Hand Surgery American volume. Among the 100 top-cited articles, nine articles were devoted to basic science and 91 articles have dealt with clinical science. There were three articles with level II, 24 articles with level III, 46 articles with level IV, and 18 articles with level V of evidences. Conclusion The current study presents an insight to the classic articles about Kienböck’s disease. The 100 top-cited articles have established a foundation that the science on Kienböck’s disease has been elaborated. The current study is likely helpful for educational purposes and further research about Kienböck’s disease. Level of Evidence Economic and decision analysis/Level IV.

scholarly journals Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?

2019 ◽  
Vol 09 (01) ◽  
pp. 039-043
Author(s):  
Arvind Mohan ◽  
Richard Knight ◽  
Hiba Ismail ◽  
Ian A. Trail
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ulnar Variance ◽  
Height Ratio ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
X Ray ◽  
Kienböck's Disease ◽  
Carpal Height ◽  
Kienbock’S Disease

AbstractCarpal height ratio and ulnar variance on plain X-ray were measured and compared to the width/height ratio of the lunate as measured on a computed tomography (CT) scan in 50 patients with Kienböck's disease. Width/height ratio of the lunate was also measured in a series of 50 controls. No correlation between ulnar variance and fractures was found. Conversely, the correlation between carpal height ratio on X-ray and width/height ratio on a CT scan was statistically significant. Similarly, the correlation between ulnar variance and width/height ratio was statistically significant. We have concluded that width/height ratio while correlating with carpal height is a better measure of lunate collapse. It also appeared that lunate collapse precedes carpal collapse, specifically most if not all lunates have collapsed prior to reduction in carpal height ratio. Finally, while we are unable to conclude the level at which the width/height ratio of lunate becomes unreconstructable, it does appear that in all Litchman stage 3b and most if not all of 3a the shape of the lunate has altered significantly.

Radial shortening, bone grafting and vascular pedicle implantation versus radial shortening alone in Kienböck’s disease

2021 ◽  
pp. 175319342199373
Author(s):  
Elsayed Said ◽  
Ahmad Addosooki ◽  
Yasser Assaghir ◽  
Ahmed Ahmed ◽  
Hamdy Tammam
Keyword(s):  
Bone Grafting ◽  
Vascular Pedicle ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Group I ◽  
Group Ii ◽  
Kienbock’S Disease

We prospectively compared outcomes of two surgical procedures for Stage II and IIIa Kienböck’s disease with negative ulnar variance. Group I (13 wrists) was treated with radial shortening alone, and Group II (14 wrists) with combined radial shortening, bone grafting and implantation of a vascular pedicle. At follow-up 3 to 7 years (mean 4.5) after operation, scores by the Quick version of the Disability of Arm, Shoulder and Hand questionnaire and scores for pain and grip strength were significantly better in Group II, but the differences were rather small. On MRI all patients in Group II had revascularization, but 11 patients in Group I had not. We conclude that combining radial shortening with the revascularization procedure improved revascularization. Clinically, both treatments were efficient, and the additional bone grafting and vascular pedicle insertion did not greatly improve function, although statistically there were differences in several follow-up variables. This study also could not identify the independent role of the three procedures (drilling, grafting and artery insertion) in Group II, because decompression or bone grafting alone may be effective. Level of evidence: II

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