Closing Radial Wedge Osteotomy for Preiser's Combined With Kienböck's Disease: Two Case Reports

Hayashi, Ousuke; Sawaizumi, Takuya; Ito, Hiromoto

doi:10.1142/s0218810409004189

Cited by 12 publications

(4 citation statements)

References 13 publications

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“…To the best of our knowledge, there have been only 5 cases of Preiser disease with concomitant Kienböck disease reported in the English literature, including these 2 cases (Table 5 ). [ 2 – 5 ] Although cases of AVN involving more than 1 carpal bone have been reported, almost all have been attributed to steroid therapy for systemic illness, such as autoimmune hemolytic anemia, [ 1 ] systemic lupus erythematosus, and renal transplantation, or have involved risk factors, such as smoking, alcohol misuse or infection. [ 2 ] The case reported by Budoff [ 2 ] had a 3-month history of steroid use and was a cigarette smoker; another case reported by Bhardwaj and colleagues [ 4 ] had been taking herbal medication that may have contained a steroid (Table 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…The CRWO seeks to addresses 2 issues in AVN: decompression of the radio-lunate and radio-scaphoid joints by enlarging the spaces between the radius and the lunate or scaphoid bone, [ 5 , 10 – 13 ] and inducing revascularization of the carpals following osteotomy. [ 11 , 12 ] Additionally or alternatively, CRWO may decompress venous hypertension in a similar way to osteotomy in AVN of the femoral head; [ 11 ] normalization of intraosseous pressure may result in the reduction of pain and consequently improve range of motion.…”

Section: Discussionmentioning

confidence: 99%

“…Although there have been reports of AVN affecting more than 1 carpal bone, [ 1 ] concurrent AVN of the scaphoid and lunate bones is very rare indeed. [ 2 – 5 ] Other cases of concurrent disease were reported in 2009, [ 5 ] and we report the medium-term results of closed radial wedge osteotomy of the distal radius (CRWO) [ 6 ] in 2 cases of Preiser disease with the concomitant Kienböck disease.…”

Section: Introductionmentioning

confidence: 99%

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Medium-term outcome of closed radial wedge osteotomy of the distal radius for Preiser disease with concomitant Kienböck disease

Tomori¹,

Sawaizumi²,

Nanno³

et al. 2017

Medicine

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Rationale:Idiopathic avascular necrosis of the scaphoid or lunate bone are known as Preiser disease and Kienböck disease, respectively. Although there are reports of avascular necrosis involving more than one carpal bone, concurrent idiopathic avascular necrosis of the scaphoid and lunate bones is rare, with only five cases reported in the English literature (including the two herein). Although the optimum treatment for Preiser disease with concomitant Kienböck disease has not been established, our cases underwent closed radial wedge osteotomy based on the evidence of satisfactory outcomes for treating Kienböck disease. We report the medium-term results of closed radial wedge osteotomy of the distal radius in two cases of Preiser disease with concomitant Kienböck disease.Patient concerns:We presented two patients with concomitant Preiser and Kienböck diseases. Although both smoked cigarettes, neither had any other risk factors; there was no history of trauma, although both women had jobs that required relatively heavy or repetitive manual labor.Diagnoses:Two patients were diagnosed by radiographs and magnetic resonance imaging of the wrists.Interventions:A non-surgical strategy of splint immobilization and analgesia was not effective, and surgery was ultimately required.Outcomes:Satisfactory medium-term results were achieved with closed radial wedge osteotomy of the distal radius in both cases. Although there was imaging evidence of progression of dorsal intercalated segmental instability deformity, neither of the patients was symptomatic and both declined salvage surgery.Lessons:We compare our cases and treatment strategy with others reported in the literature. Our cases suggest that closed radial wedge osteotomy of the distal radius is a safe and relatively straightforward means of treating patients with this rare combination of wrist disorders, and appears to obviate the need for more extensive salvage procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medium-term outcome of closed radial wedge osteotomy of the distal radius for Preiser disease with concomitant Kienböck disease

Tomori¹,

Sawaizumi²,

Nanno³

et al. 2017

Medicine

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“…Because of the rarity of the condition, defined treatment algorithms do not exist. Treatment options have included observation, arthroscopic debridement [58], closing radial wedge osteotomy [32], scaphoid excision with four-bone fusion, proximal row carpectomy, total wrist arthrodesis, transfer of a vascular pedicle, and VBGs from the dorsal and volar distal radius [42,61]. If a VBG is selected as treatment, it is essential to confirm the presence of an intact cartilaginous shell and the absence of arthritic changes at the radiocarpal and midcarpal joints (Herbert stage I or II) [66].…”

Section: Preiser's Diseasementioning

confidence: 99%

Vascularized Bone Grafts for the Treatment of Carpal Bone Pathology

Derby

Murray

Shin

et al. 2013

Hand (New York, N,Y.)

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Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.

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