The Results of Conservative Management for Early Stage 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.

Download Full-text

Kienböck’s Disease, Early Stage 3––Height Reconstruction and Core Revascularization of the Lunate

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90212-7 ◽

1994 ◽

Vol 19 (4) ◽

pp. 466-478 ◽

Cited By ~ 55

Author(s):

R. C. BOCHUD ◽

U. BÜCHLER

Keyword(s):

Bone Grafting ◽

Early Stage ◽

Disease Process ◽

Wrist Motion ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Shortening Osteotomy ◽

Final Score ◽

Carpal Height ◽

Kienbock’S Disease

Early stage 3 Kienböck’s disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases. 26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5–9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI. Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%. Overall, 43% good and excellent, 43% fair and 14% poor results were observed.

Download Full-text

Conservative management of kienbock's disease in a 24 year old adult : A case report

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703922 ◽

2015 ◽

Vol 05 (03) ◽

pp. 107-109

Author(s):

Sanath Kumar Shetty ◽

Aditya Ballal ◽

H. Ravindranath Rai

Keyword(s):

Case Report ◽

Conservative Management ◽

Radiological Findings ◽

Left Wrist ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Acceptable Range ◽

Old Adult ◽

Late Stages ◽

Kienbock’S Disease

AbstractKienbock's disease also known as Lunatomalacia is a rare disorder involving the lunate. Damage to the lunate can lead to pain, stiffness, and in late stages, arthritis of the wrist. This disease is most common in men between the ages of 20 and 40 and rarely affects both wrists. Here we present a 35 year old male manual labourer who presented to our department with complaints of progressive pain and stiffness of his dominant wrist.Radiographically he was diagnosed to have Lichtmann class IIIA Kienbock's disease of the left wrist. He was managed with analgesics and wrist physiotherapy. On a review at three months he had an acceptable range of motion of the wrist he was symptom free.This article presents our patients history, radiological findings and management.

Download Full-text

Clinical Outcomes of Patients with Stage II and IIIA Kienböck’s Disease After Undergoing Conservative Management

Indian Journal of Orthopaedics ◽

10.1007/s43465-021-00451-0 ◽

2021 ◽

Author(s):

Jae-Hoo Lee ◽

JangWon Son ◽

Min-Jong Park

Keyword(s):

Clinical Outcomes ◽

Conservative Management ◽

Stage Ii ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

Download Full-text

Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures

Journal of Wrist Surgery ◽

10.1055/s-0040-1701511 ◽

2020 ◽

Vol 09 (03) ◽

pp. 197-202 ◽

Cited By ~ 1

Author(s):

Joshua A. Gillis ◽

Joseph S. Khouri ◽

Steven L. Moran

Keyword(s):

Grip Strength ◽

Surgical Management ◽

Conservative Management ◽

Retrospective Chart Review ◽

Level Of Evidence ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Adolescent Patients ◽

Revascularization Procedures ◽

Kienbock’S Disease

Abstract Objective To evaluate the outcomes and complication rate of surgical management in adolescent patients with Kienböck's disease and compare lunate offloading and revascularization procedures. Methods We performed a retrospective chart review to evaluate adolescent patients with Kienböck's disease between 1990 and 2016 who were surgically managed. Charts were reviewed for demographic information, presence of trauma, range of motion, grip strength, and radiographic parameters pre- and postoperative. Results We assessed 21 wrists in 20 patients. All had failed conservative management and required surgery. Seven patients underwent lunate offloading procedures, most commonly radial-shortening osteotomy, whereas 13 patients had an attempt at revascularization. All patients had either minimal or no pain at a clinical mean clinical follow-up of 63.4 months. Postoperatively, grip strength and radial deviation improved, with no difference between the two groups. Those that underwent joint offloading procedures had less ulnar variance. Eight of 11 patients with a postoperative MRI (magnetic resonance imaging) had evidence of lunate revascularization after a revascularization procedure. Conclusion Surgical management of Kienböck's disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management. Level of Evidence/Type of study This is a Level IV, therapeutic study.

Download Full-text

CLOSING RADIAL WEDGE OSTEOTOMY FOR PREISER'S COMBINED WITH KIENBÖCK'S DISEASE: TWO CASE REPORTS

Hand Surgery ◽

10.1142/s0218810409004189 ◽

2009 ◽

Vol 14 (01) ◽

pp. 57-62 ◽

Cited By ~ 8

Author(s):

Ousuke Hayashi ◽

Takuya Sawaizumi ◽

Hiromoto Ito

Keyword(s):

Avascular Necrosis ◽

Clinical Evaluation ◽

Early Stage ◽

Case Reports ◽

Carpal Bone ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Appropriate Treatment ◽

Kienbock’S Disease

Avascular necrosis involving more than one carpal bone is rare, and the appropriate treatment for this condition has not yet been established. In this report, two patients with concomitant Preiser's and Kienböck's disease who also had severe wrist pain without obvious traumas were treated by closing radial wedge osteotomy (CRWO). Clinical evaluation showed that CRWO was effective against both conditions and indicated that it is more suitable for early stage than stage II diseases of the Hebert and Lichtman classifications.

Download Full-text

The Effects of Radial Core Decompression on Lunate Kinematics

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19127 ◽

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.

Download Full-text