Kienboeck's Disease Treated with Ostègotomy to Lengthen Ulna

Tillberg, Bengt

doi:10.3109/17453676808989471

Cited by 49 publications

(9 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Leaving aside a few authors who have showed good results with ulnar lengthening,15 radial shortening has been accepted as an effective modality of treatment for these stages,1 but not all patients with Kienböck's disease have negative ulnar variance as reported by Ryogo Nakamura,16 in whose study more than fifty percent of patients had zero or positive variance. Moreover the primary contraindication to consider in the operative treatment of Kienböck's disease is ulnar-positive or ulnar-neutral variance because in patients with such variance, joint-leveling procedures (radial shortening and ulnar lengthening) cannot be performed.…”

Section: Discussionmentioning

confidence: 95%

Distraction histiogenesis for treatment of Kienbock′s disease: A 2- to 8-year follow-up

Meena¹,

Saini²,

Kundanani³

et al. 2009

Indian J Orthop

View full text Add to dashboard Cite

Background:Distraction histiogenesis is known to enhance vascularity and stimulate new tissue formation. Its use in Kienbock's disease is not reported in the literature, so we proposed to study the outcome after distraction histiogenesis in treating this condition.Materials and Methods:This prospective study comprised of six patients (two male and four female) with mean age 18.16 years (range 21-35 years) with clinicoradiologically diagnosed Lichtman stage II (n = 3) and stage III (n = 3) Kienbock's disease with a mean duration of symptoms 6.67 months. The ulnar variance was neutral in two and was negative in four patients treated with the application of Joshi external stabilization system (JESS) across the wrist. The gradual distraction was done at a rate of 0.5 mm/day. After the distraction of 5-7 mm, the distractors were kept static for 3 weeks. The wrist was mobilized by using hinged distractors for next 3 weeks. Later short cockup splint was used for further 4 weeks. At the end of minimum 2 years, an assessment was done on the basis of relief of symptoms, ability to perform activities of daily living, range of movement at wrist, grip strength, and on radiology (change in the density of bone and C:MC ratio i.e ratio of carpal height to third metacarpal height).Results:The mean follow-up was of 4.5 years (range 2-8 years). The average duration of treatment was 5.3 months (range 4.5-6 months), and the duration of distraction (both static and hinged) was 8 weeks. Clinically all the patients were relieved of the symptoms with an increase in the range of wrist movement (ulnar deviation increased from 20.8° to 29.5°, radial deviation from 17.5° to 21°, dorsiflexion from 37.5° to 52.5°, and palmer flexion from 38.3° to 47.5°). At the last follow-up, activities of daily living were not affected, and all the patients were on their previous jobs without any fresh complaints. The average grip strength increased to 73-86% of normal. Radiologically the C:MC ratio (ratio of carpal height to third metacarpal height) did not show any significant improvement, but the density of lunate decreased.Conclusion:Distraction histiogenesis when used in Lichtman stage II and III with negative or neutral ulnar variance gives good symptomatic relief, allowing return to normal activities. This study has also shown that reparative process is possible in avascular bone by distraction. The authors recommend further research in this modality of treatment.

show abstract

Section: Discussionmentioning

confidence: 95%

Distraction histiogenesis for treatment of Kienbock′s disease: A 2- to 8-year follow-up

Meena¹,

Saini²,

Kundanani³

et al. 2009

Indian J Orthop

View full text Add to dashboard Cite

show abstract

“…대한정형외과학회지：제 45권 제 4호 2010 골 치환술, 두상골 이전술, 척골 연장술과 요골 단축술, 다양한 방 법의 관절 고정술 등 여러 수술 방법까지 제안되어 왔다. 3,4,[7][8][9][10][11][12]…”

Section: 색인단어: 월상골 키엔벡 병 무혈성 괴사 제 4+5 신전 구획 동맥 유경 골이식술unclassified

Treatment of Kienböck's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience

Cheon

Lim

Kim

et al. 2010

J Korean Orthop Assoc

View full text Add to dashboard Cite

show abstract

“…Described treatment options have included immobilization, lunate excision/replacement, joint-leveling (unloading) procedures, radial osteotomy, capitate shortening, vascularized and nonvascular bone grafting, partial wrist arthrodesis, proximal row carpectomy, and complete wrist fusion. 75,77,[79][80][81][82][83][84][85][86][87][88][89] Partial wrist fusion, proximal row carpectomy, and complete wrist arthrodesis have been used for late-stage disease. 90 Unfortunately, many reports in the literature are retrospective, and it is somewhat difficult to determine the optimal treatment for varying stages of Kienböck's disease.…”

Section: Vascularized Bone Grafting In the Management Of Kienbö Ck's mentioning

confidence: 99%

“…86,87 Good results for stage 1 to 3 disease including improved pain, strength, and range of motion have been published with radial-shortening or ulnar-lengthening procedures. 75,85,88,89,91 Increased nonunion rates have been associated with ulnar-lengthening procedures. 75 For patients with ulna neutral variance, 3,[96][97][98][99][100][101][102][103][104][105][106][107][108][109] Although indications continue to evolve, most surgeons would agree that VBG should be reserved for patients with intact cartilaginous shell and absence of degenerative changes.…”

Section: Vascularized Bone Grafting In the Management Of Kienbö Ck's mentioning

confidence: 99%

Vascularized Bone Grafts and Their Applications in the Treatment of Carpal Pathology

Rizzo¹,

Moran²

2008

Seminars in Plastic Surgery

View full text Add to dashboard Cite

Vascularized bone grafts (VBGs) are techniques in the management of certain types of carpal pathology. VBGs have traditionally been advocated for conditions including delayed and nonunion of fractures and avascular necrosis. The most common indications for VBG have been for scaphoid nonunion, lunatomalacia (Kienböck's disease), and osteonecrosis of the scaphoid (Preiser's disease). Advantages over NVBG have been established. VBGs provide improved blood flow, osteocyte preservation, and accelerated healing rates. Local pedicled VBGs are the most commonly used methods. They are technically less demanding than are free VBGs and are associated with less morbidity. Commonly used donor grafts arise from the dorsal vasculature of the wrist and include the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA), the 2,3 ICSRA, the fourth extensor compartment artery (fourth ECA), and the fifth ECA. A 4 þ 5 ECA combination graft has been described to provide a longer pedicle. In managing osteonecrosis, most surgeons would agree that VBG should be reserved for carpal bones with an intact cartilaginous shell and no collapse. In treating scaphoid pathology, indications for VBG include fractures/ nonunions with proximal pole avascular necrosis and/or small proximal pole fragments.

show abstract

Kienboeck's Disease Treated with Ostègotomy to Lengthen Ulna

Cited by 49 publications

References 4 publications

Distraction histiogenesis for treatment of Kienbock′s disease: A 2- to 8-year follow-up

Distraction histiogenesis for treatment of Kienbock′s disease: A 2- to 8-year follow-up

Treatment of Kienböck's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience

Vascularized Bone Grafts and Their Applications in the Treatment of Carpal Pathology

Contact Info

Product

Resources

About