Metaphyseal bone decompression of distal radius for early stages of Kienbock's disease. Minimum follow-up of 10 years.
Abstract
BackgroundThe purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of the Kienbock disease treated with radius core decompression.MethodsThis retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression that were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio. ResultsThe mean follow-up period was 13 years (range 10-18). Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to the Lichtman classification occurred in four wrists.ConclusionThis long-term follow-up study shows that radius core decompression is a valid alternative for the treatment of the early stages of the kienbock disease.Downloads
References
Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienbock’s disease. Hand Clin. 1993;9(3):409-416.
Beredjiklian PK. Kienböck’s disease. J Hand Surg Am. 2009;34(1):167-175.
llan CH, Joshi A, Lichtman DM. Kienböck's disease: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:128-36.
Tambe AD, Trail IA, Stanley JK. Wrist fusion versus limited carpal fusion in advanced Kienböck's disease. Int Orthop. 2005;29:355-8.
Afshar A, Eivaziatashbeik K. Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. J Hand Surg Am. 2013 Feb;38(2):289-9.
Elhassan BT, Shin AY. Vascularized bone grafting for treatment of Kienböck's disease. J Hand Surg Am. 2009;34:146-154.
Illarramendi AA, Schulz C, De Carli P. The surgical treatment of Kienböck’s disease by radius and ulna metaphyseal core decompression. J Hand Surg. 2001;26A:252-260.
Fujiwara H, Oda R, Morisaki S, et al. Long-term results of vascularized bone graft for stage III Kienbock disease. J Hand Surg Am. 2013;38(5):904-8.
Nattrass GR, King GJ, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am. 1994;76(1):88-94.
Stahelin A, Pfeiffer K, Sennwald G, Segmuller G. Determining carpal collapse: an improved method. J Bone Joint Surg Am 1989; 71:1400–1405
Illarramendi AA, De Carli P. Radius decompression for treatment of kienbock disease. Tech Hand Up Extrem Surg. 2003 Sep;7(3):110-3
McKay SD, MacDermid JC, Roth JH, Richards RS. Assessment of Complications of Distal Radius Fractures and Development of a Complication Checklist. J Hand Surg Am. 2001; 26: 916–22.
Martin GR, Squire D. Long-term outcomes for Kienböck’s disease. Hand (NY). 2013;8(1):23-6.
Luegmair M, Goehtz F, Kalb K, Cip J, van Schoonhoven J. Radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienbock disease. J Hand Surg Eur Vol. 2017 Mar; 42(3):253-259.
Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienböck disease. J Bone Joint Surg. 2008;90A:1705-1711.
Arora R, Lutz M, Deml C, Krappinger D, Zimmermann R, Gabl M. Long-term subjective and radiological outcome after reconstruction of Kienböck’s disease stage 3 treated by a free vascularized iliac bone graft. J Hand Surg. 2008;33A:175-181.
Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. Core decompression of the distal radius for the treatment of Kienböck’s disease: a biomechanical study. J Hand Surg Am. 2008;33:1478-1481.
Pountos I, Panteli M, Panagiotopoulos E, Jones E, Giannoudis PV. Can we enhance fracture vascularity: What is the evidence?. Injury 2014 Jun;45 Suppl 2:S49-57.
Innes L, Strauch RJ. Systematic review of the treatment of Kienböck’s disease in its early and late stages. J Hand Surg Am. 2010;35(5):713-717, 717.e1– e4.
Blanco RH, Blanco FR. Osteotomy of the radius without shortening for Kienböck’s disease: a 10-year follow-up. J Hand Surg Am. 2012;37(11):2221-5.
Copyright (c) 2018 Revista de la Asociación Argentina de Ortopedia y Traumatología
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
