Comparing the Radiologic and Functional Outcome of Radial Shortening Versus Capitate Shortening in Management of Kienböck’s Disease

Mazhar, Farid Najd; Motaghi, Paniz; Kooshesh, Mohammad Reza; Mahmoudinasab, Omid

doi:10.1177/15589447221081564

Cited by 2 publications

(2 citation statements)

References 36 publications

(38 reference statements)

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“…In a biomechanical study, Kam et al 41 showed a very similar reduction in lunate cortical strain in both radial opening wedge and closing wedge osteotomies. While others prefer capitate shortening, 42,43 there are biomechanical studies that report a risk of overloading the midcarpal joint. 37 Our preference is for a closing wedge osteotomy as it lessens the risk of nonunion associated with an opening wedge osteotomy and avoids the risk of midcarpal overload from capitate shortening.…”

Section: Intact Lunate Cortex On Computed Tomography Scanmentioning

confidence: 99%

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Tee,

Butler,

et al. 2024

J Wrist Surg

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Background In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy. Materials and Methods We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD. Results We put forward an investigative algorithm that places into context the investigative roles of MRI, arthroscopy, and CT. Conclusion KD is a rare condition, and there is a lack of comparative studies to help us choose the preferred treatment. The decision on the management options in adult KD may be made by determining the integrity of the lunate cortex and deciding whether the lunate is salvageable or not by CT scan. MRI may provide useful information on the vascular status if the lunate cortex is intact, and the lunate is salvageable. If the lunate is fragmented, it is not salvageable, and MRI does not provide useful information. Arthroscopy has a role in selective cases.

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Section: Intact Lunate Cortex On Computed Tomography Scanmentioning

confidence: 99%

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Tee,

Butler,

et al. 2024

J Wrist Surg

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“…Partial shortening of the large bone is a decompression technique for the treatment of lunatomalacia with positive or neutral ulnar variance. The large bone shortening technique done by means of a smaller cut takes less time compared to radial shortening and leads to an advantage in stage II (15,16).…”

Section: Figure 3 Degree Of Carpal Collapse By Salmon Et Al Through T...mentioning

confidence: 99%

Kienböck's Disease, Avascular Necrosis of the Lunate

Pesántez

García

Banegas

et al. 2022

EPRA

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Introduction: Avascular necrosis of the lunate bone was described in 1910 by the Austrian radiologist Robert Kienböck, which is named after him. A mixture of different factors such as mechanical, vascular and genetic predisposition may be related to the pathogenesis of this disease. As for the natural evolution of the disease, failure in early diagnosis and early treatment may lead to a gradual evolution from stage I to stage IV, causing discomfort to the patient. Objective: to detail the current information related to avascular necrosis of the lunate, description, etiology, classification, imaging presentation and management of Kienböck's disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Kienböck, avascular necrosis of the lunate and lunatomalacia. Results: it is the second most frequent cause of avascular necrosis of the carpal bones and generally affects males between 20 and 40 years of age. Nuclear magnetic resonance has a greater contribution due to greater sensitivity and detection of radiographically occult cases, computed tomography also has a good specificity at the time of diagnosis. Radiography at the beginning of the disease does not present evident changes and nuclear scintigraphy presents non-specific findings. In the first stage, the treatment is based on immobilization with a plaster cast or splints. When incomplete necrosis is evidenced in the second stage, conservative treatment can be performed, however with complete necrosis or in the third and fourth stage, it requires "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. Stage IIIA usually merits lunate restoration, in stage IIIB and Lichtman IV wrist arthrodesis can be used. Conclusions: Kienböck's disease presents with unilateral pain over the dorsal aspect of the wrist, weakness and limited wrist motion, in addition to functional impotence, decreased grip strength, wrist edema, sensory disturbances in the median nerve territory and synovitis, depending on the stage. It is related to the following variables such as ulnar minus or ulnar negative variation, vascular contribution of the lunate bone, morphology of the lunate, radial inclination angle. The diagnosis is clinical and imaging where Lichtman's classification is useful. Treatment will depend on the cause and also on the stage of the disease.

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Comparing the Radiologic and Functional Outcome of Radial Shortening Versus Capitate Shortening in Management of Kienböck’s Disease

Cited by 2 publications

References 36 publications

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Kienböck's Disease, Avascular Necrosis of the Lunate

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