Pseudoartrose em Decorrência de Osteotomia de Rádio Distal por Doença de Kienböck/  Pseudoarthrosis due to distal radius osteotomy due to Kienböck's Disease

IntroducciónEl 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. Materiales y MétodosEste 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).ResultadosEl seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II. 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. ConclusiónLa descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck.

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Pedicled Vascularized Bone Graft from the Dorsal Distal Radius for the Treatment of Kienböck's Disease

Operative Techniques: hand and wrist surgery ◽

10.1016/b978-1-4160-3659-3.50026-2 ◽

2008 ◽

pp. 249-266

Author(s):

Wendy L. Parker ◽

Alexander Y. Shin

Keyword(s):

Bone Graft ◽

Distal Radius ◽

Vascularized Bone Graft ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Vascularized Bone ◽

Kienbock’S Disease

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Existing or Worsening Symptoms of Kienböck’s Disease after Distal Radius Fracture: Two Case Reports

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

10.1142/s2424835518720359 ◽

2018 ◽

Vol 23 (04) ◽

pp. 585-588

Author(s):

Takeshi Ogawa ◽

Shunsuke Asakawa

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Case Reports ◽

Combined Therapy ◽

Compression Fracture ◽

Radius Fracture ◽

Lunate Bone ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

We report two rare cases of existing or worsening symptoms due to Kienböck’s disease after distal radius fracture (DRF). During examination, radiographs show changes in the lunate bone; there was persistent wrist pain after treatment for DRF. In each case, surgeries were performed: A combined therapy (bone marrow transfusion, bone peg graft, external fixation, and low intensity pulsed ultrasound) for one, as well as carpal coalition for another. The etiology of these case presentations suggest that a compression fracture of the lunate due to a DRF resulted in softening and sclerosis.

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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.

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Kienböck’s Disease—The Influence of Arthrosis on Ulnar Variance Measurements

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(92)90205-g ◽

1992 ◽

Vol 17 (6) ◽

pp. 701-701

Author(s):

S. S. Kristensen ◽

K. Søballe

Keyword(s):

Individual Difference ◽

Distal Radius ◽

Progressive Increase ◽

Ulnar Variance ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

The Individual ◽

Arthritic Changes ◽

Kienbock’S Disease

The individual difference in ulnar variance measurements between diseased and unaffected wrists in 38 patients with unilateral Kienhöck’s disease was determined and related to the degree of arthrosis in the affected wrists. In patients without arthrosis there was no difference in measurements. With increasing arthrosis there was a progressive increase of patients with individual difference in ulnar variance measurements: up to 50% in those with severe arthrosis. Where a difference in ulnar variance was encountered, the wrist with Kienböck’s disease represented the more negative value in 90%. It is concluded that over-representation of the so-called “ulnar minus variant” in Kienböck’s disease is based on osteo-arthritic changes in the wrist, resulting in a pseudo-lengthening of the distal radius, and that this is therefore a consequence of the disease. The “ulnar minus variant” seems to have no hearing on the cause of Kienböck’s disease.

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Long term results of distal radius shortening for Kienböck's disease

Zeitschrift für Orthopädie und ihre Grenzgebiete ◽

10.1055/s-2003-821516 ◽

2003 ◽

Vol 141 (S 1) ◽

Author(s):

EEJ Raven ◽

TW Patt ◽

RK Marti

Keyword(s):

Distal Radius ◽

Long Term Results ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

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KienbÖck’s Disease — The Influence of Arthrosis on Ulnar Variance Measurements

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_87_90178-1 ◽

1987 ◽

Vol 12 (3) ◽

pp. 301-305

Author(s):

S. S. KRISTENSEN ◽

K. SØBALLE

Keyword(s):

Individual Difference ◽

Distal Radius ◽

Progressive Increase ◽

Ulnar Variance ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

The Individual ◽

Arthritic Changes ◽

Kienbock’S Disease

The individual difference in ulnar variance measurements between diseased and unaffected wrists in 38 patients with unilateral Kienböck’s disease was determined and related to the degree of arthrosis in the affected wrists. In patients without arthrosis there was no difference in measurements. With increasing arthrosis there was a progressive increase of patients with individual difference in ulnar variance measurements: up to 50% in those with severe arthrosis. Where a difference in ulnar variance was encountered, the wrist with Kienböck’s disease represented the more negative value in 90%. It is concluded that over-representation of the so-called “ulnar minus variant” in Kienböck’s disease is based on osteo-arthritic changes in the wrist, resulting in a pseudo-lengthening of the distal radius, and that this is therefore a consequence of the disease. The “ulnar minus variant” seems to have no bearing on the cause of Kienbüock’s disease.

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