Article
The Choice of Operation for Young Patients of Kienböck’s Disease: A Case Series
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Published: | February 6, 2020 |
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Objectives/Interrogation: Kienböck's disease is a rare condition in children or adolescent patients, and incidence of these is reported to be less than 1% of the whole of cases. Because of age-related potential for spontaneous remodeling and revascularization, surgical method for young patients should be different from for adult cases. For children, temporary fixation of the scaphotrapezio-trapezoidal (STT) joint would be not only effective but also simple and less invasive, but for late teenagers with epiphyseal closure, radial shortening osteotomy (RSO) would be more reliable.
Methods: We treated 6 cases of children or adolescent patients (younger than 20 years old) of Kienböck's disease. All patients presented in Lichtman stage IIIa. As a treatment, temporary fixation of the STT joint were performed in 3 patients (bilateral in 1). The ages of the patients in this group were 11, 14 and 16 years old. A period of fixation ranged from 8 to 12 weeks. RSO was performed in the remaining 3 patients. The ages of the patients in this group were 14, 15 and 18 years old. Shortening length was 3mm and volar locking plate was used as internal fixation. For an evaluation of blood circulation improvement in the lunate, MRI images (T1WI) were compared pre- and postoperatively. Carpal height ratio and Stähl index in AP view of X ray image, the range of motion (ROM) of the wrist and grip strength were also measured and compared pre- and postoperatively.
Results and Conclusions: In 11 and 14 year-old-patients underwent temporary fixation of the STT joint, improving blood circulation of the lunate was confirmed with MRI. But in a 16-year-old patient, intensity change was not confirmed with MRI at the time of 20 months postoperatively. As a second surgery, RSO were performed and improving blood circulation was confirmed at the time of 25 months after second operation. In all patients underwent RSO primarily, improving blood circulation of the lunate was confirmed with MRI postoperatively. Carpal height ratio, Stähl index, the ROM of the wrist and grip strength were improved in all patients except 1 patient who underwent secondarily RSO. The choice of operation for young patients of Kienböck's disease should be decided by having epiphyseal plate closure or not. Temporary fixation of the STT joint can be useful in the patients before the epiphyseal closure. In contrast, RSO is recommended after the epiphyseal closure.
References
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- Kazuki K, Uemura T, Okada M, Egi T. Time course of magnetic resonance images in an adolescent patient with Kienböck’s disease treated by temporary scaphotrapezoidal joint fixation: a case report. J Hand Surg Am. 2006 Jan;31(1):63-7.