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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 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint... (Review)
Review
Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.
Topics: Arthrodesis; Arthroplasty; Biomechanical Phenomena; Bone Transplantation; Carpal Bones; Decision Trees; Denervation; Humans; Osteoarthritis; Prostheses and Implants; Radiography; Range of Motion, Articular; Wrist Joint
PubMed: 25596986
DOI: 10.1016/j.otsr.2014.06.025 -
Indian Journal of Orthopaedics Jan 2022Piezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine...
PURPOSE
Piezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine whether piezosurgery was suitable and advantageous for performing osteotomies in Hand and Plastic reconstructive surgery.
METHODS
The authors overviewed a variety of applications for Piezosurgery Device, from Mectron, in bone reconstructive surgery with over the last 8 years. An overall number of 156 bone cutting procedures in adults and children was described at the phalanges, metacarpal bones and distal radius level, as well as in bone graft harvesting and bone remodeling following carpal scaphoid nonunion, scapho-lunate bone-ligament-bone reconstruction and fibula free flap in maxillofacial defects.
RESULTS
The consolidation rate was 87.5% in scaphoid nonunion grafting and fixation. Bone healing was achieved in all other cases. No intra-operative complications were recorded.
CONCLUSION
Piezosurgery allowed high precision in bone cutting as well as custom-made graft and surface roughness were obtained, while preserving nerves, vessels and tendons integrity. The instrument may be handling moved into the surgical space in absence of vibrations, with a clear view onto the bone. The mechanical and biological characteristics of the piezoelectrical effect perfected this technique as an effective and useful instrument in Hand and Plastic surgery. The selective bone cutting properties avoided injuries to the surrounding soft tissues and thermal damage of the bony cells. Best advantages were described in feasibility and flexibility for intra-articular osteotomies, custom-made grafts and reconstructive microsurgical techniques.
PubMed: 35070144
DOI: 10.1007/s43465-021-00454-x -
BMJ Case Reports Mar 2022
Topics: Humans; Joint Dislocations; Lunate Bone; Wrist Injuries
PubMed: 35256377
DOI: 10.1136/bcr-2022-248917