Clinical and Radiological Results of the Tendon Ball Replacement for Kienboeck's Disease.
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Abstract:
Since 1984, we have treated 10 hands with Kienböck's disease at Lichtman's stage IV by replacing the lunate with a palmaris longus tendon ball. There were 9 cases (7 males, 2 females), whose ages ranged from 24 to 61 years (average 41.0 years). 5 right lunates and 5 left lunates were involved. All patients were right-handed. The period of follow-up ranged from 3 months to 6.75 years (average 3 years and 5 months). We evaluated the postoperative results clinically and radiologically.All of the 9 patients were able to return to their previous jobs. There was no significant change in the postoperative range of motion of the wrist joint. Clinical results were evaluated as excellent in 6 hands, good in 3 hands and fair in one hand according to Dornan's criteria, and satisfactory in 7 hands and unsatisfactory in 3 hands according to Lichtman's criteria. The mean preoperative ulnar variance was -0.70mm and there was no cases with plus variance. Carpal height ratio significantly changed from 0.493 preoperatively to 0.466 postoperatively (p=0.092). Most cases had a significant decrease in carpal height ratio one month after the operation. Radio-scaphoid angle did not change postoperatively.In conclusion, the replacement operation using the tendon ball was clinically effective for stage IV Kienböck's disease, but radiologically carpal height ratio decreased early after surgery.Keywords:
Kienböck's disease
Carpal bones
Lunate bone
ABSTRACT: Three cases of Kienböcks disease in which the lunate could be excised in toto afford an unusual opportunity for study of the lunate. Findings are detailed, and compared with literature on the etiology of Kienbock's disease.
Kienböck's disease
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Kienbock disease is a rare disorder involving the lunate, one of the carpal bones, and is therefore not generally included in the differential diagnosis of patients presenting to the emergency department with wrist pain. In this case report, we would like to highlight a case of Kienbock disease in a 28-year-old female patient without any medical or traumatic history. Although it is a very rare disease of the lunate, emergency physicians should consider Kienbock disease in those patients with complaints of pain, swelling and limitation of motion of the wrist. An overlooked diagnosis or misdiagnosis may lead to bony ischemia, necrosis, and ultimately collapse of the bone.
Kienböck's disease
Lunate bone
Avascular Necrosis
Wrist pain
Carpal bones
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Kienböck's disease
Lunate bone
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Kienböck's disease
Lunate bone
Fossa
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The aim of this study was to identify possible anatomical risk factors for Kienbock's disease. We measured on a posteroanterior radiograph of the wrist, in zero-position, the Lunate Diameter and Height, Lunate Tilting Angle, Lunate Uncovering Index, Lunate Fossa Inclination, Radial Inclination and Ulnar Variance. We measured these seven parameters on the unaffected hand in the Kienböck group (N = 54) to avoid the influence of arthritic changes and on the dominant hand in a control group (N = 126). Statistical significant differences were found for a smaller Lunate Diameter and Height, a more radially inclined Lunate Tilting Angle and a flatter Radial Inclination (Student's t-test). This may result in more load transmission onto the lunate, which may lead to avascular necrosis.
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Lunate bone
Avascular Necrosis
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The authors present an overview of surgical treatment of I-IV Degree aseptic necrosis of the lunate. They deal in detail with the transposition of os pisiforme which is indicated in compressive changes of the lunate bone in III and IV degrees of Decoulx classification. They present the surgical procedure verified on anatomical cadavers. Transposition of os pisiforme to the space left after the extirpated lunate preserves the integrity of proximal line of carpal bones, the fundamental geometrical indexes of carpus are fully restored or they are only insignificantly changed. The evaluation of the group of patients operated on by the authors will be published. Key words: Kienbóck disease, lunate bone.
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Transposition (logic)
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Kienbock disease is caused by aseptic necrosis of the lunate. The aim of this work is to evaluate the results of the radial shortening procedure for the treatment of stages II. Illa IIb of the disease. We retrospectively reviewed 20 cases of Kienbock disease. This series is composed of 9 men and 11 women. The average age was 32 years. According to Litchman's classification; 17 patients were operate on in stage III (14 IIIa; 311Ib) and 3 patients were operate on in stage III. Average of shortening was: 4 mm. the mean Follow -up was 05 years. Functional results were evaluated according to Michon score. The results were good in 18 cases and poor in 02 cases. Radiologic results were good: Ameliorations were obtained in 3 patients with stage II; 16 stabilizations in 17 patients with stage IIIa and 1 deterioration in 4 patients with stage IIIb. Radial shortening is effective in the treatment of Kienbock disease in wrists that do not have degenerative changes in adjacent carpal joints. Pain, range of motion and strength can be expected to improve but the radiographic aspect of the lunate changes is not likelly to undergo much chance, if any. Osteotomy was effective even in patients who had zero or positive ulnar variance; and an inclination angle of the distal part of the radius.
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Radial osteotomy has been recommended for stages II and III-a of Kienböck's disease because of it's load decreasing effect on the lunate. Recently usefullness of this procedure in the tratment of advanced stage Kienböck's disease has been demonstrated clinically by several authors. In contrast, the effects of this procedure on the biomechanics of the degenerative arthritis of wrist advanced Kienböck's disease are unclear. In this study, we studied 17 patients with stage III and IV Kienböck's disease to analyse the precise radiographic consequence of radial wedge osteotomy for progressive stage Kienböck's disease.12 patients who underwent the radial closing wedge osteotomy and 5 patients who underwent radial shortening osteotomy for the treatment of advanced Kienböck's disease were reviewed clinically and radiographically. There were 7 males and 10 females, whose average age was 51 years. 5 were stage III-a, 10 were III-b and 2 were stage IV. The average follow-up period was 2 years and 3 months. The following measurements were made for radiographic assessment: the angle of radial inclination, ulnar variance, carpal height ratio, Ståhl index, radio-lunate angle, radio-scaphoid angle, scapho-lunate angle, carpal-ulnar distance ratio, lunate covering ratio, and ring to proximal pole distance.The radial inclination decreased from 26.8° to 15.7 in the wedge osteotomy group. The ulnar variance increased 2mm in the radial shorening group. The carpal height ratio decreased from 0.509 to 0.504 and Ståhl index increased from 36% to 37%, both without statistical significance (p<0.01) in the wedge osteotomy group. In addition, the radio-scaphoid angle increased significantly (p<0.01) in the wedge osteotomy group.The increased lunate covering ratio is believed to increase the area of distribution of the axial load through the lunate by increasing the contact area with the radius. In addition, the increased radio-scaphoid angle is believed to correct the radio-carpal malalignment in patients with advanced stage Kienböck's disease. The satisfactory clinical outcome of radial closing wedge osteotomy is believed to be due to both these effects on carpal alignment.
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Carpal bones
Lunate bone
Scaphoid bone
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Kienböck's disease
Lunate bone
Carpal bones
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