Characteristic features and natural evolution of Kienböck's disease: Five years' results of a prospective case series and retrospective case series of 106 patients

Stahl, Stéphane; Hentschel, P.; Held, Manuel; Manoli, Theodora; Meisner, Christoph; Schaller, Hans-Eberhard; Stahl, Adelana Santos

doi:10.1016/j.bjps.2014.05.037

Cited by 13 publications

(6 citation statements)

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“…This situation is rarely described in the literature, and emphasizes the need to evaluate the vascularity of the proximal scaphoid pole better, because most of the cases were intermediate grade, rather than complete necrosis or fully viable bone. Other pathologies that involve avascular necrosis have been studied in more detail, such as Kienböck's disease or avascular necrosis of the maxilla [35,36]. Therefore, our data provide prognostic information regarding this difficult condition, and further experimental and clinical studies are required to determine the successful surgical outcome, depending on the histological pattern.…”

Section: Discussionmentioning

confidence: 89%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to correlate the preoperative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.

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Section: Discussionmentioning

confidence: 89%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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“…Demographic parameters and stage distributions were comparable among all treatment groups except when comparing the pre-operative stages in the RSO group and in the RSO and VBG groups. However, group classification according to the initial stage of KD was not performed for the following reasons: (1) it has been previously suggested that initial KD stage, according to Lichtman, has no influence on treatment outcome [ 25 , 26 ]; (2) the validity of current classifications has been questioned because arthritis of the lunate can be observed in the absence of lunate fracture or carpal collapse [ 1 ]; (3) the reliability and comparability of KD stages in literature is limited because no distinction is generally made regarding the localization of arthritis (lunate cartilage, lunate facet, or the entire radiocarpal joint) and because there is no consensus regarding the diagnostic requirements for KD and associated arthritis (X-ray, MRI, CT scan, or arthroscopy) [ 1 ]; (4) because KD may progress from a preserved lunate shape to fragmentation within 6 months [ 1 ], staging may not be accurate if more than 4 weeks have elapsed between diagnosis and surgery; (5) a correlation between radiological parameters of KD classifications and the clinical course has not been established, while many authors have observed a poor correlation with clinical findings [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…If no response was received in the following 6 weeks, the patients were contacted by telephone, and an appointment for the clinical examination was arranged during which the self-assessment questionnaire was given to the patient. The questionnaire was developed by a multidisciplinary team consisting of one occupational physician, two hand surgeons, one psychiatrist, and one epidemiologist, as previously described [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…Recent case–control studies [ 1 , 2 ], systematic reviews [ 2 , 3 ], and a meta-analysis [ 2 ] have shown that neither high-level nor good quality scientific evidence exists to support any of the hypotheses regarding the etiology of KD published in the literature. Therefore, causal treatment of KD has to be critically evaluated on the basis of evidence of restored trabecular architecture, lunate shape and wrist geometry (effectiveness), and a superior success rate compared to other treatments in comparative studies (efficacy).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

et al. 2015

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PurposeThe clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck’s disease (KD) progression exists.MethodsOut of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups.ResultsThere were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant.ConclusionsThe study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease.Level of evidenceTherapy, level III, retrospective comparative study with prospectively collected data.

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“…• Previous wrist injuries • Genetic predisposition 38,39 • Kienböck's disease 40 • Preiser's disease 41 • Rheumatoid arthritis • Postinfectious arthritis…”

Section: Cartilage Injuries and Carpal Bone Fracturesmentioning

confidence: 99%

Cartilage Injuries and Posttraumatic Osteoarthritis in the Wrist: A Review

2021

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Objective: Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions and to understand the pathomechanisms leading to wrist cartilage injuries and OA, a literature review on the subject was performed combined with a presentation of one of the authors’ own experience. Design: This study includes a literature review of the topic. As a comparison to the review findings, the observations of one of the authors’ consecutive 48 wrist arthroscopies, were assessed. PubMed, Scholar, and Cochrane databases were searched using the keywords “cartilage injury AND wrist AND treatment” and “wrist AND cartilage AND chondral AND osteochondral AND degenerative OA.” :Result A total of 11 articles, including 9 concerning chondral and osteochondral repair and treatment and 2 regarding posttraumatic OA, were retrieved. The cartilage repair treatments used in these articles were drilling, osteochondral autograft, juvenile articular cartilage allograft, and chondrocyte implantation. One article displayed concomitant cartilage injuries in displaced distal radius fractures in 32% of the patients. The review of our findings from a 1-year cohort of wrist arthroscopies showed 17% cartilage injuries. Conclusion: There is a lack of knowledge in current literature on cartilage injuries and treatment, as well as posttraumatic OA in the wrist. Cartilage injuries appear to be common, being found in 17% to 32% of all wrist arthroscopies after trauma, but no guidelines regarding conservative or surgical treatment can be recommended at the moment. Larger prospective comparative studies are needed.

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Characteristic features and natural evolution of Kienböck's disease: Five years' results of a prospective case series and retrospective case series of 106 patients

Cited by 13 publications

References 20 publications

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

Cartilage Injuries and Posttraumatic Osteoarthritis in the Wrist: A Review

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