Kitty Wu, George S Athwal, Douglas Ross
CASE: A 50-year-old woman involved in a motorcycle accident sustained a transscaphoid transcapitate perilunate fracture dislocation with complete extrusion of the proximal scaphoid pole and lunate as a unit into the forearm. The patient underwent urgent open reduction and internal fixation (ORIF) with screw fixation of the capitate and Kirschner wire fixation of the scaphoid, midcarpal joint, and lunotriquetral intervals. At 1-year postoperatively, radiographs confirm healing of capitate and scaphoid fractures, with no signs of avascular necrosis of the lunate...
July 2020: JBJS Case Connector
James P Higgins, Heinz K Bürger
Vascularized osteochondral flaps are a new technique described for the reconstruction of challenging articular defects of the carpus. The medial femoral trochlea osteochondral flap is supplied by the descending geniculate artery. This osteochondral flap has shown promise in the treatment of recalcitrant scaphoid proximal pole nonunions and advanced avascular necrosis of the lunate. The anatomy, surgical technique, and results are discussed, with clinical cases provided.
October 2020: Clinics in Plastic Surgery
Gregory I Bain, Sathya Vamsi Krishna, Simon Bruce Murdoch MacLean, Parth Agrawal
Background  Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to "unload" the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique  We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease...
August 2020: Journal of Wrist Surgery
Mohammed Tahir Ansari, Deepak Chouhan, Vikas Gupta, Akram Jawed
Avascular necrosis of the lunate, commonly known as Kienböck's disease is a disorder that can lead to carpal collapse and the need for surgeries, which can stabilize the wrist. There are different associations with the disease but the exact etiology is unknown. Kienböck's disease is believed to result from mechanical and vascular factors in genetically predisposed individuals. The newer classification based on advanced wrist arthroscopy and MRI help in a better understanding of the disease, early diagnosis, and treatment...
July 2020: Journal of Clinical Orthopaedics and Trauma
Shih-Wen Kao, I-Chang Chang, Chih-Lung Wu
Acute lunate and perilunate dislocations are not commonly observed injuries. In particular, palmar-divergent dislocation is a very rare injury with only a few cases reported in the literature. In this report, we describe the case of a 37-year-old patient with palmar-divergent dislocation of the scaphoid and lunate and discuss the mechanism of this type of injury. We also report a potential treatment for this pattern of palmar-divergent dislocation. The scapholunate and scaphocapitate joints were stabilized with K-wires and a modified pin-in-plaster fixation for 5 weeks after successful closed reduction...
May 22, 2020: Acta Orthopaedica et Traumatologica Turcica
Yujian Xu, Yongqing Xu, Haotian Luo, Xiaoqing He, Xulin Zhang, Wanqiu Zhao, Huan Wu, Libo Yuan
Objective: To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique. Methods: Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software...
May 15, 2020: Chinese Journal of Reparative and Reconstructive Surgery
X Ye, J-T Feng, H-W Yin, Y-Q Qiu, Y-D Shen, W-D Xu
Vascularized bone grafts have shown favorable outcomes in Kienböck's disease, preventing the progression of lunate collapse and avascular necrosis. Here we describe our experience using a 4+5 extensor compartmental artery (ECA) vascularized bone graft combined with K-wire fixation. Between September 2010 and June 2013, 9 patients with Lichtman stage II-IIIA disease underwent arthroscopy prior to 4+5 ECA graft placement combined with temporary fixation (scaphocapitate and triquetrum-capitate joints). The average follow-up was 69 months (range, 51-92 months)...
May 2020: Hand Surgery and Rehabilitation
Metin Gönen, Ali Çağdaş Yörükoğlu, A Nadir Aydemir, Gizem Akıncı Gönen, Emre Tepeli, A Fahir Demirkan
PURPOSE: Plasminogen activator inhibitor 1 (PAI-1) is a critical enzyme that regulates coagulation and fibrinolytic systems. The aim of this study was to determine the role of PAI-1 4G/5G polymorphism in nontraumatic avascular necrosis of the lunate. METHODS: The study included 45 patients with Kienböck disease and 45 healthy individuals as a control group. In both groups, genomic DNA was extracted from peripheral blood samples to determine the distributions of PAI-1 4G/5G polymorphism using allele-specific polymerase chain reaction and sequencing...
December 2, 2019: Journal of Hand Surgery
Milad Heydari-Kamjani, Sadaf Afraz, Danay Herrera, Michelle Demory Beckler, Marc M Kesselman
Kienböck's disease is characterized by avascular necrosis of the lunate. Its pathophysiology involves a complex interplay of repetitive microtrauma, anatomical and vascular variances. Early diagnosis of this entity is challenging as disease presentation is nonspecific and can mimic common wrist pathologies such as fractured or sprained wrist. Here we report a case presentation of Kienböck's disease Stage IIIA in a 28-year-old healthy male. Initial radiographs of the left wrist were inconclusive and two weeks later the diagnosis was confirmed with a magnetic resonance imaging...
October 19, 2019: Curēus
Ahmadreza Afshar, Ali Tabrizi
Avascular necrosis (AVN) of the carpal bones other than Kienböck disease is a rare cause of chronic pain of the wrist. The scaphoid, capitate, and a smaller percent of lunates are at greater risk to develop AVN because of their peculiar intraosseous circulation; however, AVN has been reported in all the carpal bones. On the plain radiograph, AVN of the carpal bones may evolve through a normal radiograph, sclerosis, fragmentation, cyst formation, fracture, bone collapse, change of the carpal height, and alignment and progressive degenerative changes of the wrist joint...
February 2020: Journal of Hand Surgery
Anas M Alyamani, Mohammed F Alfawzan, Turki S Alhassan, Obaid M Almeshal
INTRODUCTION: Lunate dislocation is a rare and serious injury, frequently due to high-energy trauma such as a fall from height or a motor vehicle accident. Lunate dislocation is usually in the volar direction; however, dorsal dislocation of the lunate is extremely rare. PRESENTATION OF CASE: We report a case of 55-year-old male who sustained a high-energy trauma; he was hit by a car while crossing the street. The patient was referred to department of Plastic Surgery for left wrist dorsal dislocation of the lunate and bilateral multiple carpal bone fractures...
2019: International Journal of Surgery Case Reports
Ahmet Nadir Aydemir, Metin Gönen, Ali Çağdaş Yorukoğlu, Mehmet Yücens, Ahmet Fahir Demirkan
OBJECTIVES: This study aims to clinically evaluate the efficacy of pedicle bone flap treatment in stage II Kienböck's disease. PATIENTS AND METHODS: This retrospective study included 10 patients (8 males, 2 females; mean age 33.3 years; range, 23 to 46 years) treated with pedicle bone flap between January 2012 and June 2016. In all patients, a fourth extensor compartment artery (ECA) pedicle bone flap from the dorsal surface of the radius was prepared and placed through a window opened on the lunate bone...
August 2019: Joint Diseases & related Surgery
Seok Woo Hong, Young Hak Roh, Hyun Sik Gong, Goo Hyun Baek
Avascular necrosis (AVN) is relatively uncommon in the carpal bones, although it most frequently involves the lunate and scaphoid. The trapezoid has abundant vascular channels from a rich network of dorsal and palmar vessels, and only a few cases of AVN have been reported in adults who sustained a traumatic insult. We present a rare case of idiopathic AVN of the trapezoid in an adolescent presenting with refractory pain at the second metacarpal base. Over a period of 36 months, follow-up symptom evaluations and serial magnetic resonance images showed prominent gradual improvement, consistent with spontaneous resolution...
February 4, 2019: Journal of Hand Surgery
Kevin Chan, William Engasser, Peter J L Jebson
Various surgical treatment options have been described to address chronic scapholunate dissociation. The Scapholunate Axis Method (SLAM) is a new technique used to reconstruct the scapholunate interosseous ligament. It is biomechanically advantageous compared with other ligament reconstruction techniques but clinical studies are lacking. We describe a previously unreported complication of avascular necrosis of the lunate after the SLAM procedure.
December 19, 2018: Journal of Hand Surgery
Peter C Noback, David P Trofa, Lucas K Dziesinski, Evan P Trupia, Samuel Galle, Melvin P Rosenwasser
BACKGROUND: Patients with limited health literacy require online educational materials to be written below a sixth grade level for optimal understanding. We assessed the quality, accuracy, and readability of online materials for Kienböck disease (KD). METHODS: "Kienbock's Disease" and "Lunate Avacular Necrosis" were entered into 3 search engines. The first 25 Web sites from each search were collected. Quality was assessed via a custom grading rubric, accuracy by 2 residents and a fellow, and readability by Flesch-Kincaid grade level (FKGL) and New Dale-Chall test...
December 16, 2018: Hand: Official Journal of the American Association for Hand Surgery
Avi D Goodman, Andrew P Harris, Joseph A Gil, Joseph Park, Jeremy Raducha, Christopher J Got
Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes. [Orthopedics. 2019; 42(1):e1-e6.].
January 1, 2019: Orthopedics
Paulo Jorge Figueira, Diogo Alpuim Costa, Nunzio Barbagallo, Francisco Gamito Guerreiro
Kienböck's disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck's disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2...
October 12, 2018: BMJ Case Reports
A Švarc, J Pilný, M Repko, T Kastenberger, M Eichinger
PURPOSE OF THE STUDY This study aims to evaluate the results of patients treated by proximal row carpectomy at a follow-up of at least 5 years after the surgery. MATERIAL AND METHODS A total of 25 patients were treated by proximal row carpectomy for degenerative changes of the wrist as a consequence of the previous trauma or avascular necrosis of the lunate bone, of whom 21 patients underwent a follow-up examination at least 5 years postoperatively. Proximal row carpectomy was indicated in 15 patients for SLAC wrist, in 4 patients for avascular necrosis of the lunate bone, in 1 patient for SNAC wrist, and in 1 patient for inveterate dislocation of the wrist...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Yuji Tomori, Norio Motoda, Ryuji Ohashi, Takuya Sawaizumi, Mitsuhiko Nanno, Shinro Takai
RATIONALE: Preiser disease or avascular necrosis (AVN) of the scaphoid causes intolerable wrist pain and malalignment of the carpal bones. In previously reported cases, patients have had a history of steroid use for systemic illness such as autoimmune hemolytic anemia, systemic lupus erythematosus, or renal transplantation, or have had other risk factors, such as smoking, alcoholism, or infection. In particular, systemic glucocorticoid therapy has been most commonly associated with the disease...
September 2018: Medicine (Baltimore)
Kitty Wu, Clare Padmore, Emily Lalone, Nina Suh
PURPOSE: Fragmentation of the scaphoid proximal pole secondary to avascular necrosis presents a difficult reconstructive problem. This anthropometric study assesses the utility of the ipsilateral proximal hamate for complete osteochondral scaphoid proximal pole reconstruction. METHODS: Twenty-nine cadaveric specimens underwent computed tomography scanning and 3-dimensional reconstruction of the carpus and distal radius. Scaphoid height was measured and a third of its height was used to simulate resection of the proximal scaphoid pole and extent of hamate autograft required...
January 2019: Journal of Hand Surgery
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