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>

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.

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.

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.

scholarly journals Follow-up Study of Kienbock's Disease.

1993 ◽  
Vol 42 (3) ◽  
pp. 1199-1202
Author(s):  
Naoto Satou ◽  
Masahiro Shirahama ◽  
Kensuke Yamanaka ◽  
Akio Inoue ◽  
Kenji Yoshida ◽  
...  
Keyword(s):  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Follow Up Study ◽  
Kienbock’S Disease

scholarly journals Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

2019 ◽  
Vol 08 (04) ◽  
pp. 264-267 ◽  
Author(s):  
J. C. Botelheiro ◽  
Silvia Silverio ◽  
Ana Luísa Neto
Keyword(s):  
The Other ◽  
Stage Iiib ◽  
X Rays ◽  
Carpal Collapse ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
The Past ◽  
Shortening Osteotomy ◽  
Flexion Extension ◽  
Kienbock’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.

Scaphotrapeziotrapezoid (STT)-Arthrodesis in Kienböck’s Disease

2004 ◽  
Vol 29 (6) ◽  
pp. 580-584 ◽  
Author(s):  
R. MEIER ◽  
M. VAN GRIENSVEN ◽  
H. KRIMMER
Keyword(s):  
Functional Result ◽  
Contralateral Side ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Long Term Effect ◽  
Advanced Stages ◽  
The Mean ◽  
Kienbock’S Disease

This study reviews the results of 59 of 84 patients with severe Kienböck’s disease who were treated with STT fusion. The average follow-up period was 4 (ranges: 2–8) years. The average arc of wrist extension and flexion was 67° (60% of the contralateral side, 81% of pre-operative range) and that of ulnar and radial deviation was 31° (52% of the contralateral side, 56% of pre-operative range). Pre-operative pain values (VAS) were 56 (non-stress) and 87 (stress) and were significantly higher than the postoperative values of 12 (non-stress) and 41 (stress). Grip strength improved from 45 kPa pre-operatively to 52 kPa postoperatively. The mean modified Mayo wrist score was 63 points. The patients reported low disability in the DASH scores, with an average of 28 points. Our data show that STT fusion is a reliable and effective treatment for pain relief and offers a good functional result in advanced stages of Kienböck’s disease. However the long-term effect of this procedure on radioscaphoid and other intercarpal joints is yet to be determined.

scholarly journals Long Term Outcomes of the Radius Core Decompression for the Early Stages of the Kienböck’s Disease

2017 ◽  
Vol 42 (9) ◽  
pp. S13-S14
Author(s):  
Pablo De Carli ◽  
Ezequiel Ernesto Zaidenberg ◽  
Jorge Boretto ◽  
Gerardo L. Gallucci ◽  
Agustin Donndorff
Keyword(s):  
Core Decompression ◽  
Long Term Outcomes ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Kienbock’S Disease

Radial Closing Wedge Osteotomy for Kienböck’s Disease: an Over 10 Year Clinical and Radiographic Follow-Up.

2002 ◽  
Vol 27 (2) ◽  
pp. 175-179 ◽  
Author(s):  
A. WADA ◽  
H. MIURA ◽  
H. KUBOTA ◽  
Y. IWAMOTO ◽  
Y. UCHIDA ◽  
...  
Keyword(s):  
Long Term Results ◽  
Wedge Osteotomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Closing Wedge Osteotomy ◽  
Radial Inclination ◽  
Closing Wedge ◽  
Joint Contact ◽  
Kienbock’S Disease

Thirteen patients with Kienböck’s disease who had undergone a radial closing wedge osteotomy were reviewed clinically and radiologically at a follow-up mean of 14 years. Good long-term results were obtained in all patients. Their levels of pain were improved, and significant increases were seen in the range of motion and grip strength. Radiographic stage, as assessed by Lichtman’s classification, improved in one, did not change in four, and advanced in eight patients. The radial inclination angle significantly decreased and the carpal-ulnar distance and lunate covering ratios both increased, demonstrating that radial shift in the alignment of the carpal bones occurs and that the joint contact area of the lunate increases in proportion to the decrease in radial inclination. The preoperative radiolunate and radioscaphoid angles, which were significantly larger than those of the unaffected wrist, did not change postoperatively which shows that this technique was not able to correct the flexion deformity of the lunate and the scaphoid.

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