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Orthopaedics & Traumatology, Surgery &... Feb 2022The cause of Kienböck's disease is still unclear. It was initially considered as osteomalacia, before being recognized as avascular necrosis of the lunate. Its... (Review)
Review
The cause of Kienböck's disease is still unclear. It was initially considered as osteomalacia, before being recognized as avascular necrosis of the lunate. Its functional prognosis is doubtful, given that the progression often leads to wrist degeneration. Conservative treatment does not provide good results in adults; thus surgery is often needed. Certain anatomical factors such as the ulnar variance, configuration of the lunate or orientation of the radial glenoid have turned out not to contribute to necrosis but may contribute to lunate fracture. The lunate's vascularization can be precarious and mostly depends on the capsular arterioles. The lunate is a very mobile bone that participates in wrist movements, both in the radiocarpal joint and especially in the mid-carpal joints during activities of daily living. Radiographs are not the only diagnostic tools. The lunate makes contact with the radius and triangular fibrocartilage complex and is often subjected to high shear loads at the edge of the radius that can cause it to fracture. MRI and arthroscopy can contribute to the assessment. Kienböck's disease is likely an inflammatory, biological venous thrombosis disorder that leads to local damage due to intraosseous compartment syndrome. The basis of surgical treatment is to decompress the lunate to shield it from shear and compression loads. Existing osteotomy procedures will be described and compared to better understand their biomechanical effects. Some osteotomies do not reduce the loads transmitted to the lunate but can reduce the risk of intra-osseous shear. Some osteotomies may place excessive pressure on the lunate on its ulnar side. Some techniques are extra-articular and preserve the capsule's vascularization along with the anatomy of the mid-carpal joint. When the lunate damage is so severe that the bone's viability is compromised, bone grafting or replacement have been proposed. The palliative techniques typically used for wrist degeneration are indicated in the terminal stages. There are currently no effective biological treatments. While the origin of Kienböck's disease is still unknown, we now know that decompression osteotomies, while they do not heal the necrosis, protect the lunate from collapse, which hopefully provides enough time for biological healing to occur.
Topics: Activities of Daily Living; Adult; Fractures, Bone; Humans; Lunate Bone; Necrosis; Osteonecrosis; Radius; Ulna; Wrist Joint
PubMed: 34861414
DOI: 10.1016/j.otsr.2021.103161 -
Journal of Clinical Orthopaedics and... 2020The triangular fibrocartilage complex (TFCC) is a well defined anatomical entity located on the ulnar aspect of the wrist joint functioning primarily to stabilize the...
The triangular fibrocartilage complex (TFCC) is a well defined anatomical entity located on the ulnar aspect of the wrist joint functioning primarily to stabilize the distal radio -ulnar joint (DRUJ) and also to act as a shock absorber across the ulno-carpal joint. Palmer and Werner were first to explain the anatomic details of the TFCC and to describe its biomechanical role at the wrist. The TFCC comprises of the fibro-cartilagenous disc, the dorsal and palmar ligaments spanning across radius and ulna, the ulno-carpal ligaments, a meniscal homolog, and the sub sheath of ulnar extensor of the wrist. The intricate anatomy of this area and complex load transmission kinematics renders it vulnerable to injury and attrition. Both traumatic and degenerative insults produce specific injury patterns which can present as vague ulnar-sided wrist pain particularly during forearm rotation. These injuries are managed initially by modification of daily activities to avoid aggravation of pain and injury, by complete abstinence from sporting/gym/yoga maneuvers which involve stressing the wrist joints, temporary splint or cast immobilisation are also used along with non-steroidal anti-inflammatory medication. Corticosteriod injection are also used in conjunction with physical therapy in grossly symptomatic patients. Surgical treatment is advocated if conservative management fails to provide relief, or in cases presenting initially with frank instability of the DRUJ or with unstable and displaced fractures. Choice of operative treatment is guided by type and extent of injury and may include debridement, repair and in TFCC injuries associated with degenerative changes, ulnar unloading procedures like shortening or Wafer procedure. With current understanding of arthroscopic anatomy of the wrist, availability of instrumentation as well as familiarity of surgeons with this tool, arthroscopic management can be instituted successfully in most if not all conditions afflicting the TFCC.
PubMed: 32742122
DOI: 10.1016/j.jcot.2020.06.001 -
American Family Physician Nov 2018Braces and splints can immobilize and protect joints, reduce pain, decrease swelling, and facilitate healing of acute injuries. They are also used for injury prevention... (Review)
Review
Braces and splints can immobilize and protect joints, reduce pain, decrease swelling, and facilitate healing of acute injuries. They are also used for injury prevention and chronic pain reduction, and to alter the function of a joint. The medial unloading (valgus) knee brace is an option for patients with medial knee osteoarthritis, but evidence of long-term benefit is limited. The patellar stabilizing brace helps maintain proper patellar alignment but has mixed results in treating patellofemoral pain syndrome. The patellar tendon strap is effective in treating pain from patellar tendinopathy. The knee immobilizing splint is used after surgery to prevent reinjury and for acute or presurgical management of quadriceps rupture, patellar tendon rupture, medial collateral ligament rupture, patellar fracture or dislocation, and other acute traumatic knee injuries. Use of a functional ankle brace is more effective than immobilization or a compression wrap in terms of functional outcomes after an acute ankle sprain and prevention of future ankle sprains. The thumb spica splint is effective for the treatment of thumb carpometacarpal osteoarthritis and de Quervain tenosynovitis, and may be used for patients with suspected scaphoid fractures. A wrist splint has short-term effectiveness in treating symptoms of carpal tunnel syndrome but may not be more effective than other conservative therapies.
Topics: Braces; Humans; Musculoskeletal Diseases; Musculoskeletal System; Splints
PubMed: 30365284
DOI: No ID Found