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Jegal and Park: The Results of Conservative Management for Early Stage Kienbock's Disease
ORIGINAL ARTICLE

J Korean Soc Surg Hand 2014;19(4):180-188.

Published online: 11 December 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.4.180

The Results of Conservative Management for Early Stage Kienbock's Disease

Midum Jegal, Min Jong Park

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Min Jong Park, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea, TEL: +82-2-3410-3506, FAX: +82-2-3410-0061, E-mail: mjp3506@skku.edu

Received 3 December 201415 December 2014       Accepted 15 December 2014

Copyright © 2014 The Korean Society for Surgery of the Hand

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Early stage Kienböck's disease is commonly treated with a surgical intervention to avoid progression to degenerative change. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative management in patients with an early stage Kienböck's disease with a hypothesis that the lunate can be maintained in patients with no pain or tolerable pain.

Methods:

Twenty-three patients with a Lichtman stage I, II or IIIA Kienböck's disease were managed conservatively and investigated prospectively. There were ten men and thirteen women. Mean age at first visit was 53.9 years old and mean follow-up period was 51.3 months. The clinical outcomes were evaluated by range of motion, subjective satisfaction of patients at final follow-up. Radiographic measurements of the Lichtman stage were assessed at first visit and at the final follow-up. Three patients were Lichtman stage I, eleven patients were II and nine patients were IIIA.

Results:

Range of motion improved in all cases. According to Dornan's criteria, eleven patients were excellent, another eleven patients were good and one patient was fair. Based on Lichtman stage, no change was seen in sixteen patients, while seven showed progression. Three patients revealed improved radiographic findings of the lunate at final follow-up.

Conclusion:

We found that conservative management including close observation of clinical and radiographic changes can provide satisfactory clinical improvement in patients with no pain or tolerable pain in early stage Kienböck's disease.

Keywords: Kienböck's disease, Early stage, Conservative management

REFERENCES

1. Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienbock's disease. Hand Clin. 1993; 9:409–16.
2. Allan CH, Joshi A, Lichtman DM. Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg. 2001; 9:128–36.
3. Beredjiklian PK. Kienbock's disease. J Hand Surg Am. 2009; 34:167–75.
4. Mirabello SC, Rosenthal DI, Smith RJ. Correlation of clinical and radiographic findings in Kienbock's disease. J Hand Surg Am. 1987; 12:1049–54.
5. Delaere O, Dury M, Molderez A, Foucher G. Conservative versus operative treatment for Kienbock's disease. A retrospective study. J Hand Surg Br. 1998; 23:33–6.
6. Kristensen SS, Thomassen E, Christensen F. Kienbock's disease: late results by non-surgical treatment. A follow-up study. J Hand Surg Br. 1986; 11:422–5.
7. Dornan A. The result of treatment of Kienbock's disease. J Bone Joint Surg Br. 1949; 31:518–20.
8. Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienbock's disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am. 1977; 59:899–908.
9. Moran SL, Cooney WP, Berger RA, Bishop AT, Shin AY. The use of the 4+5 extensor compartmental vascularized bone graft for the treatment of Kienbock's disease. J Hand Surg Am. 2005; 30:50–8.
10. Salmon J, Stanley JK, Trail IA. Kienbock's disease: conservative management versus radial shortening. J Bone Joint Surg Br. 2000; 82:820–3.
11. Ozalp T, Yercan HS, Okcu G. The treatment of Kienbock disease with vascularized bone graft from dorsal radius. Arch Orthop Trauma Surg. 2009; 129:171–5.
12. Innes L, Strauch RJ. Systematic review of the treatment of Kienbock's disease in its early and late stages. J Hand Surg Am. 2010; 35:713–717.e4.
13. Mennen U, Sithebe H. The incidence of asymptomatic Kienbock's disease. J Hand Surg Eur Vol. 2009; 34:348–50.
14. Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 2010; 35:549–54.
15. Taniguchi Y, Tamaki T, Honda T, Yoshida M. Rotatory subluxation of the scaphoid in Kienbock's disease is not a cause of scapholunate advanced collapse (SLAC) in the wrist. J Bone Joint Surg Br. 2002; 84:684–7.
16. Luo J, Diao E. Kienbock's disease: an approach to treatment. Hand Clin. 2006; 22:465–73.
17. Taniguchi Y, Nakao S, Tamaki T. Incidentally diagnosed Kienbock's disease. Clin Orthop Relat Res. 2002; (395):121–7.
18. Dias JJ, Lunn P. Ten questions on Kienbock's disease of the lunate. J Hand Surg Eur Vol. 2010; 35:538–43.
19. Schmitt R, Heinze A, Fellner F, Obletter N, Struhn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997; 25:92–103.
crossref
20. Arnaiz J, Piedra T, Cerezal L, et al. Imaging of Kienbock disease. AJR Am J Roentgenol. 2014; 203:131–9.

Fig. 1.
(A) Lichtman stage IIIA (case 2, female/56 years) (B) At 3 years, subchondral fracture of the lunate was seen. (C) At 6 years, subchonral fracture was almost healed. (D) At 14 years, although mild collapse of the lunate progressed, carpal height was maintained with no pain.
jkssh-19-180f1.tif
Fig. 2.
(A) Lichtman stage I (case 13, female/61 years) (B) At 3 months, subchondral fracture of the lunate was seen. (C) At 6 months, radial side of the lunate was collapsed. (D) At 2 years, definite collapse of the lunate corresponding to Lichtman stage IV was seen.
jkssh-19-180f2.tif
Fig. 3.
(A) Lichtman stage IIIA (case 3, male/19 years) (B) At 2 years, sclerosis of the lunate almost disappeared. (C) At 3 years, cystic change of the lunate was decreased. (D) At 9 years, sclerosis of the lunate disappeared completely meaning successful revascularization.
jkssh-19-180f3.tif
Table 1.
Patient profiles
Case Gender Age at first visit (yr) Dominant side Involved side Occupation Symptom duration before first visit (mo) History of trauma Follow-up period (mo)
1 Female 50 Right Right Farmer 8 No 83.5
2 Female 56 Right Right Housewife 10 Wrist sprain 174.0
3 Male 19 Right Right Student 8 No 112.7
4 Male 33 Right Right Office job 3 Wrist sprain 94.5
5 Male 50 Right Right Delivery clerk 1 Fall 91.1
0 Male 53 Right Left Office job 1 No 12.9
7 Female 56 Right Left Housewife 12 No 85.6
8 Female 60 Right Left Housewife 24 No 68.6
9 Male 41 Right Right Office job 8 Golf 60.1
10 Male 56 Right Left Office job 12 No 13.2
11 Female 53 Right Right Office job 12 No 38.3
12 Female 48 Left Left Housewife 5 Wrist sprain 42.8
13 Female 61 Right Left Housewife 3 Fall 43.7
14 Female 72 Right Left Housewife 24 No 32.8
15 Female 68 Right Left Housewife 24 No 45.9
16 Female 55 Right Right Farmer 12 No 20.3
17 Male 31 Right Right Gymnastic instructor 3 Tennis 14.2
18 Male 52 Right Right Library manager 1 Fall 20.3
19 Female 81 Right Right Housewife 3 No 38.5
20 Male 55 Right Left Office job 3 Golf 21.7
21 Female 59 Right Left Cook 7 No 22.5
22 Female 67 Right Left Housewife 12 Fall 28.8
23 Male 67 Right Left Unemployed 3 Golf 13.6
Table 2.
Doman's criteria
Grade Criterion
Excellent No complaints and capable of full work without difficulty
Good Capable of full work without loss of time, but symptoms after very heavy use
Fair Improvement in symptoms but unable to resume heavy work
Poor No improvement, with persistent weakness and pain in the wrist
Table 3.
Clinical and radiographic results
Case Dornan's criteria Lichtman stage Ulnar variance (mm) Carpal height ratio
First visit Follow-up First visit Follow-up
1 Good 2 3A 2.37 0.51 0.51
2 Excellent 3A 3A 0 0.53 0.52
3 Good 3A 3A 2.1 0.54 0.52
4 Good 1 1 1.6 0.54 0.53
5 Excellent 2 2 3.1 0.52 0.53
6 Good 3A 3B 1.9 0.52 0.48
7 Excellent 3A 3A 2.1 0.48 0.44
8 Excellent 3A 3A 3.6 0.52 0.52
9 Good 2 3A 2 0.55 0.55
10 Excellent 2 3A 0 0.55 0.55
11 Good 3A 3A 3.4 0.46 0.43
12 Excellent 3A 3A 0 0.53 0.51
13 Fair 1 4 3.35 0.52 0.50
14 Good 2 2 3.62 0.48 0.47
15 Good 2 2 1 0.45 0.47
16 Excellent 2 3A 0 0.49 0.45
17 Good 2 2 0 0.51 0.50
18 Excellent 3A 3A –1.10 0.52 0.51
19 Excellent 3A 3A 2.6 0.52 0.51
20 Excellent 2 3A –1.50 0.52 0.53
21 Good 2 2 3.5 0.55 0.55
22 Good 2 2 0 0.51 0.51
23 Excellent 1 1 0 0.51 0.50
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