Kienböck’s disease in an elderly patient treated with proximal row carpectomy

Thomas, Anil A.; Rodríguez, E Martínez; Segalman, Keith A.

doi:10.1016/j.jhsa.2004.02.013

Cited by 11 publications

(5 citation statements)

References 7 publications

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“…9 In the elderly patient, Kienböck disease behaves differently in comparison to the pediatric and adult cohorts. [10][11][12][13][14] In Kienböck patients older than 70 years, there is less negative ulnar variance, a higher prevalence in women, who had more advanced radiological changes. 11 At a mean follow-up of 5.6 years, all 15 patients progressed to stage IV disease but had good-to-excellent clinical outcomes without surgery.…”

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confidence: 99%

Kienböck Disease: A New Algorithm for the 21st Century

2016

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Background It has been over 100 years since the initial description of avascular necrosis of the lunate. Over the last two decades, there has been the introduction of advanced information regarding the etiology, natural history, classification, and treatment options for lunate osteonecrosis. There have been new classifications developed based on advanced imaging, perfusion studies of lunate viability, and arthroscopic assessment of the articular cartilage. Purpose This article brings together a new treatment algorithm, incorporating the traditional osseous classification system (Lichtman) with the perfusion/viability classification (Schmitt) and the articular cartilage classification (Bain). Methods We have developed a new algorithm to manage Kienböck avascular necrosis of the lunate. This new algorithm incorporates the current concepts of the diseased lunate and its effects on the remainder of the wrist. Conclusion For patients with a good prognosis and in the earliest stages, the "intact lunate" is initially protected utilizing nonoperative measures. If this fails, then appropriate lunate unloading procedures should be considered. If the lunate is "compromised" then it can be reconstructed with a medial femoral condyle graft or proximal row carpectomy (PRC). With the further collapse of the lunate, the wrist is then also compromised, with the development of secondary degeneration of the central column articulation. The "compromised wrist" will have functional articulations, which allows motion-preserving procedures to be utilized to maintain a functional wrist. With advanced disease (Kienböck disease advanced collapse), the wrist is not reconstructable, so only a salvage procedure can be performed. Other than these objective pathoanatomical factors, the final decision must accommodate the various patient factors (e.g., age, general health, lifestyle, financial constraints, and future demands on the wrist) and surgeon factors (skill set, equipment, and work environment).

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confidence: 99%

Kienböck Disease: A New Algorithm for the 21st Century

2016

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“…Surgical treatments may be offered if the pain does not ameliorate with nonsurgical managements. [1][2][3][4][5][6][7][8][9] Taniguchi et al operated on 2 out of 15 wrists of elderly with Kienböck disease with excision arthroplasty and managed 13 wrists nonsurgically. All the patients achieved good and excellent clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Many cases of elderly patient with Kienböck disease may be found in the large case series describing Kienböck disease. [1][2][3][4][5][6][7][8][9] Kienböck disease after fracture-dislocations around the wrist is a rare occurrence. This case report presents a case of an elderly patient who developed Kienböck disease 18 months after distal ulnar fracture.…”

Section: Introductionmentioning

confidence: 99%

Kienböck Disease in a 66-Year-Old Man after Distal Ulna Fracture

Afshar

Tabrizi

Aidenlou

2021

Journal of Hand and Microsurgery

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Kienböck disease after fracture-dislocations around the wrist is a rare occurrence. This case report presents a case of a 66-year-old man who developed Kienböck disease 18 months after his distal ulnar fracture. The patient developed negative ulnar variance after union of the distal ulnar fracture. Nonsurgical treatment was not effective in relieving his pain. Radial shortening osteotomy was performed based on the negative ulnar variance that developed. One year postoperatively, visual analog scale improved to 0, grip strength improved to 25 kg, and flexion-extension arc improved to 150 degrees. The patient achieved satisfactory clinical outcomes. This is a therapeutic level IV study.

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“…Заболевание чаще всего наблюдается у мужчин от 18 до 40 лет [3]. У по-жилых людей болезнь встречается крайне редко, а особенно на обеих кистях.…”

Section: Discussionunclassified

“…Болезнь Кинбека (аваскулярный некроз по-лулунной кости запястья) у больных старше 60 лет встречается крайне редко и описана в единичных работах [1,2,3]. В доступной нам русскоязычной литературе мы таких случаев не обнаружили, поэтому считаем, что будет полезно ознакомить врачей с довольно редкой патологией.…”

Section: Introductionunclassified

Bilateral Kienböck’s Disease in an Elderly Patient

Goloborod'ko¹

2016

Novosti Khirurgii

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Болезнь Кинбека (аваскулярный некроз полулунной кости запястья) чаще всего наблюдается у муж-чин от 18 до 40 лет, а у людей старше 60 лет встречается крайне редко и описана в единичных работах, тем более на обеих кистях. В статье приводится чрезвычайно редкий случай двусторонней болезни Кинбека у пожилого пациента. Мужчина 63 лет обратился с жалобами на резкие боли при движениях и особенно во время физической нагрузки в области правого лучезапястного сустава, уменьшение амплитуды активно-пассивных движений в суставе и нарушение трудоспособности. Боли и ограничение движений в правом лучезапястном суставе возникли без особой причины около 7 месяцев тому назад. Состояние постепенно ухудшилось. Консервативное лечение не проводилось. После клинического и рентгенологического обсле-дования установлен диагноз: болезнь Кинбека правого запястья III Б стадии.Выполнена карпэктомия проксимального ряда костей запястья. Результат лечения был оценен через 13 месяцев после операции. Пациент субъективно отмечал значительное уменьшение болей при физиче-ской нагрузке, улучшение функции конечности и трудоспособности. Увеличилась амплитуда пассивных движений в лучезапястном суставе. Во время контрольного осмотра пациент также отметил, что 2 месяца тому назад без причины появились боли и в левом лучезапястном суставе. Была выполнена рентгенография и обнаружена болезнь Кинбека левого запястья III Б стадии. От какого-либо лечения мужчина отказался. Через 3 года после операции во время телефонного опроса пациент сообщил, что состояние проопериро-ванной конечности не ухудшилось. Ключевые слова: заболевания кисти, полулунная кость, двусторонняя болезнь Кинбека, аваскулярный не-кроз, карпэктомия, физическая нагрузка, пожилой пациентKienböck's disease (avascular necrosis of the carpal lunate) occurs most often in men aged 18 to 40 years as for the patients older than 60 yrs it observes extremely rare (especially on both hands) and is described in a few works.The article presents an extremely rare case of bilateral Kienböck's disease in the elderly patient. A patient of 63-yr-old complained of a sharp pain in the right wrist when moving and especially during physical activity, reduction of amplitude of the active-passive movements in joint and working ability infringement. Pain and limitation of movement in the right wrist appeared for no reason 7 months ago. The condition gradually deteriorated. Conservative treatment wasn't carried out. After clinical and radiographic examination Kienböck's disease stage IIIB was diagnosed.Proximal row carpectomy was performed. Treatment outcome was assessed 13 months after the surgery. The patient subjectively noted a significant pain relief during physical activity, improvement of limb function and disability. The amplitude of passive movements at the wrist joint was increased. During a follow-up the patient also said that pain without any reason had appeared in the left wrist 2 months ago. X-ray was performed and Kienböck's disease stage IIIB of the left wrist was found out. The man refused any treatment...

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Kienböck’s disease in an elderly patient treated with proximal row carpectomy

Cited by 11 publications

References 7 publications

Kienböck Disease: A New Algorithm for the 21st Century

Kienböck Disease: A New Algorithm for the 21st Century

Kienböck Disease in a 66-Year-Old Man after Distal Ulna Fracture

Bilateral Kienböck’s Disease in an Elderly Patient

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