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Heather L Baltzer, Scott Riester, Steven L Moran
Background: The etiology of multifocal osteonecrosis is not definitively known; however, hypercoagulable state is a very plausible cause. Methods: We present an unusual case of a 12-year-old boy with a history of Legg-Calve-Perthes disease presenting with right wrist pain who was subsequently diagnosed with Kienbock's disease. The finding of multifocal osteonecrosis prompted testing for a hypercoagulable state that was positive for Factor V Leiden thrombophilia. A thorough literature review using Medline database was conducted to investigate associations between inherited hypercoagulable states and multifocal osteonecrosis...
September 2016: Hand: Official Journal of the American Association for Hand Surgery
Jouni Havulinna, Jarkko Jokihaara, Pasi Paavilainen, Olli V Leppänen
Coronal plane fracture of lunate in Kienböck disease is a challenging problem with no proven treatment. We present a technique for the treatment. A vascularized bone graft from the distal radius employing the fourth and fifth extracompartmental artery pedicles is used as a mechanical support in order to enable fracture union. The technical pearls and pitfalls are described and a clinical case is presented.
September 20, 2016: Journal of Hand Surgery
Abolfazl Bagherifard, Davod Jafari, Hassan Keihan Shokouh, Ebrahim Motavallian, Farid Najd Mazhar
BACKGROUND: Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock's disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. OBJECTIVES: The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist...
May 2016: Trauma Monthly
Mohamed Ali Sbai, Hichem Msek, Sofien Benzarti, Monia Boussen, Riadh Maalla
Treatment of Kienböck's disease has historically been determined by staging, ulnar variance, and presence or absence of arthritic changes. With the advent of newer techniques of vascularized bone grafting, the status of the cartilage shell of the lunate has become another factor that can influence the procedure performed. The purpose of this article is to describe the technique of Kuhlmann vascularized bone graft for Kienböck's disease. In addition, the indications, contraindications, and outcomes are described...
2016: Pan African Medical Journal
Takaaki Shinohara, Ryogo Nakamura, Etsuhiro Nakao, Hitoshi Hirata
We retrospectively reviewed 12 patients (3 men and 9 women, with a mean age of 72 years) who were surgically treated for carpal tunnel syndrome associated with Kienböck disease. All patients except 1 were incidentally diagnosed with Kienböck disease and had little or no wrist pain. Radiographic tests revealed advanced Kienböck disease in all patients. Intraoperative findings indicated that the site of maximum compression on the median nerve was located at the level of the carpal tunnel inlet in 11 patients, and the volar dislocated fragment of the lunate was located proximally adjacent to the floor of the carpal tunnel inlet...
August 2016: Nagoya Journal of Medical Science
G Xiong, Z Xiao, H Wang, S Guo, J Tao
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...
August 24, 2016: Journal of Hand Surgery, European Volume
Alicia Cowan, Joao Panattoni
Kienböck disease, or lunate avascular necrosis, can lead to chronic wrist pain and instability. Its etiology appears to be multifactorial including variations in adjacent anatomical structures, interrupted blood supply, and trauma. Capitate-hamate fusion is the second most commonly diagnosed carpal coalition and not treated unless symptomatic. Coalitions may alter the wrist mechanics depending on their extent. No prior reports have associated Kienböck disease with capitate-hamate coalition. We present 2 cases with congenital capitate-hamate fusion and lunate AVN...
October 2016: Journal of Hand Surgery
Saroj K Golay, Philippa Rust, David Ring
BACKGROUND: To determine the prevalence of incidental Kienböck disease. METHODS: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK. RESULTS: There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups...
June 2016: Archives of Bone and Joint Surgery
Il-Jung Park, Hyoung-Min Kim, Jae-Young Lee, Youn-Tae Roh, Do-Yeol Kim, Neung-Han Jeon, Yong-Deok Kim, Soo-Hwan Kang
BACKGROUND: Vascularized bone grafts for the treatment of Kienböck's disease may facilitate revascularization and remodeling of the avascular lunate. The aim of this study was to evaluate the radiological and clinical results obtained when a fourth extensor compartmental artery (ECA) bone graft was used to treat Kienböck's disease. METHODS: Between May 2009 and June 2012, 13 patients (6 men, 7 women) with Kienböck's disease were treated with placement of fourth ECA vascularized bone grafts...
October 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Gregory P Kolovich, Chidimma M K Kalu, Michael E Ruff
BACKGROUND: The cause and treatment of Kienböck disease is controversial. No treatment algorithm has been accepted. We surveyed US hand surgeons to determine trends and attitudes regarding the treatment of Kienböck disease. METHODS: An online questionnaire was created focusing on specific treatments of Kienböck disease. The survey included 6 questions regarding the cause of disease, preferred vascularized bone grafting (VBG) procedure, and treatment of stages I, II, IIIA, and IIIB...
March 2016: Hand: Official Journal of the American Association for Hand Surgery
Toshiyasu Nakamura
No abstract text is available yet for this article.
May 2016: Journal of Wrist Surgery
Roque H Blanco, Fernando R Blanco, Fernando Cervigni
We present the radiographic results of four patients with Kienböck disease who had undergone a simple lunate excision at 26, 30, 35, and 43 years after surgery.
May 2016: Journal of Wrist Surgery
Marion Burnier, Guillaume Herzberg, Roland Chapurlat, Stéphanie Boutroy
We report a patient with stage IIIB Kienböck disease treated with radial shortening where preoperative and sequential postoperative imaging were done using in vivo high-resolution peripheral quantitative micro-computed tomography (micro-CT) scan. Sequential in vivo micro-CT scan analysis of a target zone of the Kienböck lunate of this patient demonstrated early signs of lunate remodeling (bone trabecular densification) at 5-month follow-up suggesting an ongoing healing process. These early remodeling micro-CT scan signs were confirmed at 5 years' follow-up as well...
May 2016: Journal of Wrist Surgery
Makoto Nakagawa, Shohei Omokawa, Tsutomu Kira, Kenji Kawamura, Yasuhito Tanaka
Purpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients...
May 2016: Journal of Wrist Surgery
Masahiro Tatebe, Sukuki Koh, Hitoshi Hirata
Background Kienböck disease is an aseptic necrosis of the lunate of unknown etiology, prevalent in young adults. Treatment aims to lower forces on the lunate, decrease pain and improve function. We conducted a retrospective evaluation of the 10-year clinical and radiological outcomes of radial osteotomy as a treatment for Kienböck disease. Materials and Methods We analyzed pain, grip strength, wrist range of motion (ROM), radiological carpal geometry, and staging of osteoarthritic changes over a 10-year period, postosteotomy, for 18 patients...
May 2016: Journal of Wrist Surgery
Wouter F van Leeuwen, Stein J Janssen, David Ring
PURPOSE: The natural course of the pathophysiology of Kienböck disease is uncertain. Shortening of the radius is believed to modify the pathophysiology by addressing mechanical influences on the lunate. The aim of this study was to compare the radiographic progression of Kienböck disease among patients who had radial shortening osteotomy and patients who had no surgical treatment, with a minimum 1-year interval between radiographs. METHODS: Among 207 patients with Kienböck disease, we included all 48 eligible patients who had either radial shortening osteotomy or nonsurgical treatment and 2 sets of wrist radiographs available a minimum of 1 year apart...
June 2016: Journal of Hand Surgery
Luiz Garcia Mandarano-Filho, Débora Schalge Campioto, Márcio Takey Bezuti, Nilton Mazzer, Cláudio Henrique Barbieri
OBJECTIVE: : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis. METHODS: : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique. RESULTS: : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values...
November 2015: Acta Ortopedica Brasileira
David M Lichtman, William F Pientka, Gregory I Bain
Over the past decade, a plethora of new information has been reported regarding etiology, natural history, classification, and treatment options for lunate osteonecrosis. New disease classifications have been described based on advanced imaging determination of lunate viability as well as a cartilage-based arthroscopic classification. Here we review the newest literature regarding Kienböck disease and present a new treatment algorithm that incorporates the traditional osseous classification system with a perfusion/viability classification and an articular cartilage-based classification...
May 2016: Journal of Hand Surgery
Maysara Abdelhalim Bayoumy, Hesham A Elkady, Hatem G Said, Amr El-Sayed, Waleed Riad Saleh
Palmer devised a classification system to guide treatment of triangular fibrocartilage complex tears in 1989. The main division is between traumatic Type I and atraumatic Type II tears. The wrist arthroscopy makes diagnosis and treatment of ulnar impaction syndrome possible in a less invasive way. Arthroscopy is the most valuable tool for diagnosis and treatment of acute scapholunate and lunotriquetral dissociation. Arthroscopic grading of Kienböck's disease better describes articular damage compared with plain radiographs and can help surgical treatment...
December 2015: Journal of Orthopaedics
Christian Windhofer, Victor W Wong, Lorenz Larcher, Ebrahim Paryavi, Heinz K Bürger, James P Higgins
PURPOSE: This study examines donor site morbidity associated with the medial femoral trochlea (MFT) when used as a donor site for vascularized osteochondral flaps for reconstruction of challenging carpal defects such as proximal pole scaphoid nonunion and advanced Kienböck disease. METHODS: The retrospective study population included all patients who had undergone MFT flap harvest for scaphoid or lunate reconstruction. Chart review, patient questionnaires, and validated knee function assessment tools were used: International Knee Documentation Committee Subjective Knee Form scores ranged from 0 (maximal disability) to 100 (no disability)...
May 2016: Journal of Hand Surgery
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