Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up

Carli, Pablo De; Zaidenberg, Ezequiel Ernesto; Alfie, Verónica; Donndorff, Agustín; Boretto, Jorge G.

doi:10.1016/j.jhsa.2017.05.017

Cited by 21 publications

(17 citation statements)

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“…This would benefit pathologies such as scaphoid proximal pole nonunion or Kienbock where the vascular aspect is compromised. 8 This theoretical framework is reinforced by the study of Sherman et al, 15 where they demonstrated that the metaphyseal core decompression does not alter the forces transmitted through the radiocarpal joint. In their study of radius osteotomies for Kienbock disease treatment, Kam et al 16 concluded that the mechanical discharge obtained would not be the physiological basis through which the osteotomy acts; rather, they stated that a fibrovascular stimulus secondary to this gesture would be the basis for the success of the osteotomies in the treatment of this pathology.…”

Section: Discussionmentioning

confidence: 97%

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Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

et al. 2019

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Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

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Section: Discussionmentioning

confidence: 97%

“…Through this window, the cancellous metaphyseal bone was impacted without removing it toward the other three cortices, dorsal, ventral, and ulnar, with special caution taken to not compromise them. 4,8 After surgery, the wrist was immobilized in a below-elbow cast.…”

Section: Surgical Techniquementioning

confidence: 99%

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

et al. 2019

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“…Una vez en el hueso cortical, se creó una ventana ósea de 1 cm de lado en la metáfisis a través de la cual se impactó el hueso esponjoso ubicado desde la osteotomía hacia las otras tres corticales -dorsal, ventral y cubital-con especial precaución de no dañarlas. 4,7 Luego se desperiostizaron las corticales alrededor de la osteotomía y se cerraron las partes blandas respetando sus planos. Tras el procedimiento, se les colocó a los pacientes un yeso antebraquipalmar.…”

Section: Técnica Quirúrgicaunclassified

“…Ilustración del radio distal que muestra la técnica del bloqueo óseo metafisario: a través de una ventana de cortical de 2 cm de largo y 1 cm de ancho, se impacta con una cureta el hueso esponjoso con especial cuidado de no dañar las corticales. (Reproducido con permiso de los autores 7 ).…”

Section: A Figuraunclassified

Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis. [Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis ]

Rellán¹,

Gallucci²,

Boretto³

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado.Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH.Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8.Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. ABSTRACTObjective: To report the consolidation rate and the outcomes of a series of 22 patientswith proximal pole scaphoid nonunion treated with a metaphyseal core decompressionand an anterograde self-compressing screw.Methods: We present a prospective series of patients with proximal pole scaphoidnonunion and confirmation of intraoperative bleeding in both fragments. Patientspresenting with displacement, degenerative changes, proximal pole fragmentation,cavitation at the fracture site, reduced bone length, and necrosis, as well as those withcarpal instability, were excluded. X-rays and computed tomography scans wereperformed to assess consolidation; range of motion and grip strength were recorded, andpatients completed a visual analogue scale for pain at rest, pain during activity, andsubjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder andHand) questionnaire.Results: Eighteen patients were included. Union was observed in 17 patients. Theaverage follow-up time was 22 months, and the average final range of motion was asfollows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnardeviation, and 85% for grip strength. The average score on the visual analogue scalewas 0 for pain at rest, 2 for pain during activity, and 9 for function, while the averageDASH score was 8.Conclusions: Using this simple and reliable technique, we obtained a 95% union andvery good functional results. Metaphyseal core decompression with an antegrade screwis a valid and effective alternative for treatment of proximal pole scaphoid nonunion incarefully selected patients.

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“…9 The procedures advocated for treating advanced Kienbock's disease include radius core decompression, vascularized bone graft, radial osteotomy, radial shortening, capitate shortening, limited wrist arthrodesis, implant resection arthroplasty, proximal row carpectomy and total wrist fusion. [10][11][12][13][14][15][16][17] Wrist denervation grew in popularity as an adjunct or alternative to salvage procedures for many chronic wrist conditions. 18 The goal of wrist denervation is restored or improved hand motion achieved by severing the Aδ and C fibers to the wrist joint.…”

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confidence: 99%

Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

Abodonia¹,

Elbadawy²,

Basha³

2019

Int J Res Orthop

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Background: Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment option for stage III Kienbock’s disease.Methods: This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a lawyer. The average follow up period was 14.2 months.Results: Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5. Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90 mmHg representing 93.2% of the contralateral side.Conclusions: Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion.

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Radius Core Decompression for Kienböck Disease Stage IIIA: Outcomes at 13 Years Follow-Up

Cited by 21 publications

References 19 publications

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis. [Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis ]

Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

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