Distraction osteogenesis for ulnar lengthening in Kienbock’s disease

Abstract

Ulnar lengthening is an accepted modality of treatment to achieve joint levelling in Kienbock's disease. The conventional method of ulnar lengthening with a plate and bone graft is fraught with complications including graft site morbidity, non-union, hardware removal and difficulty in the achievement of a proper length. We used a Umex distractor to achieve distraction osteogenesis in a group of 12 patients and assessed them over an average follow-up period of 29.5 months. We had one excellent, ten good and one fair result. We conclude that distraction osteogenesis addresses all the complications of coventional lengthening in addition to providing an increase in the local blood supply, which might be beneficial in a disease that is primarily an avascular necrosis. This procedure addresses both the biomechanical and the biological aspects of this disease.Résumé L'allongement du cubitus est un traitement habituel pour obtenir l'élargissement de l'interligne articulaire dans la maladie de Kienbock. La méthode conventionnelle avec greffe et fixation par plaque est obéré par des complications comme la morbidité du prélèvement, la non consolidation, la difficulté de régler la longueur et la nécessité d'ablation du matériel. Nous avons utilisé un distracteur Umex pour faire une ostéogénèse en distraction chez 12 patients étudiés avec un recul moyen de 29,5 mois. Il y avait un résultat excellent, dix bons et un moyen. Nous concluons que la distraction évite les complications habituelles de l'allongement et, en outre, augmente la vascularisation locale ce qui peut être bénéfique dans cette maladie qui est une nécrose avasculaire.

Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis

“…8 Negative ulnar variance has been postulated to be more predisposing to this disease. 9 Nine patients (81.2%) in this study had a negative ulnar variance. The treatment depends on the staging of the disease and the aim is to provide acceptable wrist function with no pain by decompressing the forces across lunate.…”

“…10 It has been shown that even if there is no radiological arthrosis, arthroscopically both radioscaphoid and capitolunate joints have shown joint damage, hence joint levelling procedures, as well as proximal row carpectomy, was not thought to be suitable and limited intercarpal arthrodesis was advised. 9 Furthermore, there have been no comparative studies, randomized or nonrandomized, which prove the superiority of any one procedure over the other. The outcomes of both joint levelling, as well as limited arthrodesis, in various studies are presented in ►Tables 3 and 4.…”

The Management of Kienböck Disease: A Survey of the ASSH Membership

“…The goals for treatment include pain relief, motion preservation, and maintenance of strength and function, 16 although there is insufficient evidence supporting the superiority of any single treatment procedure that can consistently and reliably achieve these goals. 17 Additionally, there is a lack of level 1 evidence from large, prospective, randomized trials comparing different treatment options for Kienböck disease, as this is a rare disease making it difficult to obtain enough power to obtain statistically significant results [18][19][20][21][22][23][24][25][26][27][28][29][30][31] ; thus, the aim of this study was to determine the current trends and common practices by hand surgeons for the treatment of Kienböck disease at different Lichtman stages.…”

In vitro biomechanical testing of a micro external skeletal fixator

“…A new universal micro external fixator system (UMEX TM ) has been introduced in human medicine to treat delicate orthopaedic conditions (26). The UMEX system is available in a smaller (alpha) and a larger (beta) clamp size and may prove to be a valuable alternative in the treatment of long-bone fractures in very small animals.…”