Conservative Versus Operative Treatment for Kienböck’s Disease

Delaere, O.; Dury, M.; Molderez, A; Foucher, G.

doi:10.1016/s0266-7681(98)80214-3

Cited by 73 publications

(50 citation statements)

References 11 publications

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“…The etiology and pathogenesis of the disease are still uncertain, but several mechanical, vascular, and metabolic factors have been proposed [4,5,11,12,18]. The natural history of Kienböck is incompletely understood [3]. Progression of lunate osteonecrosis can ultimately lead to collapse and fragmentation of the diseased bone with or without secondary distortion of the carpal alignment [2].…”

Section: Introductionmentioning

confidence: 99%

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Leeuwen

Janssen

Meulen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Section: Introductionmentioning

confidence: 99%

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Leeuwen

Janssen

Meulen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…stages I-IIIa), the severity of radiological changes in the lunate does not always correlate with the symptoms. (10,11) There are various treatment modalities that address the different pathologies of this disease. A recent meta-analysis, which evaluated the various treatment modalities for Kienböck's disease, showed that subjective pain improved regardless of treatment type, whereas objective improvement in grip strength and range of movement occurred only in patients who received either joint levelling surgeries or VBG, and not in those who had nonsurgical treatments.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Kienböck’s disease in twelve cases: a mid-term follow-up study

Gupta¹,

Pruthi

Kumar³

et al. 2014

smedj

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METHODSA total of 12 patients (9 male and 3 female) with Kienböck's disease were included in the present case series.The mean age of the 12 patients was 28 years. One patient presented in Lichtman stage I, five in Lichtman stage II, five in Lichtman stage IIIa, and one in Lichtman stage IV. Univariate and multivariate analyses of the obtained data were performed to identify any correlations. RESULTSThe mean follow-up time was 62 months, and the mean modified Mayo wrist score improved from the preoperative value of 29.5 to the final value of 89.6. Lichtman stage at presentation showed moderate positive correlation with the duration of symptoms (r = 0.56), and a strong negative correlation with the preoperative and final modified Mayo scores (r = -0.89 and r = -0.77, respectively). The final modified Mayo score showed moderate negative correlation with the duration of the symptoms (r = -0.55). There was a significant difference in the preoperative modified Mayo scores of patients who presented in stage II and those of patients who presented in stage IIIa (p = 0.03). However, the difference in the final modified Mayo scores of the patients in these stages was not significant (p = 0.14). CONCLUSIONLichtman's stage is moderately related to the duration of symptoms, suggesting natural progression of the disease. The final outcomes of stages II and IIIa were the same irrespective of the surgical treatment (radial shortening and/or vascularised bone grafting).

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“…Contradictory results also exist in comparing surgical and nonsurgical treatments. Delaere and associates found comparable outcomes with surgically treated patients, operated using various techniques, and conservatively treated with a mean of 5-year follow-up [5]. Salmon and colleagues, however, found that surgically treated patients (radial shortening) with stage II and III disease experienced less pain and demonstrated superior grip strength than their conservatively treated counterparts at a mean follow-up of 3.6 years [18].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes for Kienböck's Disease

Martin

Squire

2012

Hand (New York, N,Y.)

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Background The precise etiology of Kienböck's disease is unclear. Controversy exists regarding the appropriate treatment modality. The present study sought to investigate and compare surgical and nonsurgical treatment outcomes of patients suffering from Kienböck's disease in the province of Newfoundland and Labrador (NL), Canada. Methods The present study was a retrospective analysis of 66 patients. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Student's t test was used to assess differences in outcomes between treatment groups. One-way ANOVA was used to assess differences in primary outcome in time since first assessed in an effort to examine progression over time. Pearson correlation was used to assess for correlation between primary outcome and age at diagnosis. Results The average age was 38.6± 11.4 (18-70) years; Four patients were excluded due to inaccessible imaging. Of the remaining patients, 44 were treated conservatively, while 18 were treated surgically. The DASH scores for the surgical group were 23.7±24.5 (0.9-82.8) and nonsurgical group were 20.0±20.1 (1.7-81). As expected, the surgical group was mainly comprised of late-stage Kienböck's. When both groups were compared, there was no significant difference in the DASH scores. There were no difference in DASH scores within groups according to time since first diagnosed (<5 years; between 5 and 10 years; and >10 years). A positive correlation was found between age at diagnosis and DASH score (r00.42, p00.007), despite treatment modality. This finding remained significant after accounting for confounding factors (p00.029). Conclusion The DASH score for the surgical group was 23.7±24.5 (0.9-82.8) and nonsurgical group was 20.0± 20.1 (1.7-81). No significant difference in DASH scores was found between surgically and nonsurgically treated patients. A positive association was found between the age at diagnosis of Kienböck's and DASH score, which suggests that patients diagnosed and treated later in life tend not to do as well.

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Conservative Versus Operative Treatment for Kienböck’s Disease

Cited by 73 publications

References 11 publications

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Outcome of Kienböck’s disease in twelve cases: a mid-term follow-up study

Long-Term Outcomes for Kienböck's Disease

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