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7.6 Vascularized pronator quadratus-enveloped radial bone flap arthroplasty for advanced Kienböck's disease
ARTICLE IN PRESS 34
flexion–extension and radial–ulnar motion recovered respectively 94% and 92% of the contralateral side. Grip strength was 99% compared to the opposite side. All patients, except one (complaining of soreness after exertion), were satisfied. There were no complications. Conclusions: Our results are in agreement with recent literature on acute percutaneous fixation of scaphoid fractures. The Twin-Fixtscrew has always achieved stable fixation allowing consolidation with early return to job or sport activity. 10.1016/j.jhsb.2006.03.084
7.6 VASCULARIZED PRONATOR QUADRATUS-ENVELOPED RADIAL BONE FLAP ARTHROPLASTY FOR ADVANCED KIENBO¨CK’S DISEASE
G. H. Baek, M. S. Chung, H. S. Gong, Y. H. Lee, J. K. Kim and S. K. Lee Seoul National University College of Medicine, Korea Background: There has been no general agreement for the treatment of advanced Kienbo¨ck’s disease. Since 1982, we performed a kind of lunate replacement arthroplasty, which includes excision of the lunate and insertion of a vascularized pronator quadratus-enveloped radial bone flap, for the stage IIIB or IV Kienbo¨ck’s disease. Aim: We present our procedure and the outcome of 41 patients who were followed-up for more than 3 years postoperatively. Patients and methods: Forty-eight patients were treated by our method. Seven patients were lost to follow-up, and 41 patients came to the hospital for direct examinations and were included in this study. The mean age at the time of their operation averaged 39 (range, 19–58) years. Thirteen of them were stage IIIB and 28 were stage IV. The duration of follow-up averaged 6.1 (range, 3–22) years. Results: All patients reported improvement of their symptoms and 20 out of 41 patients became painless after the operation. Postoperative extension and flexion of the wrist were increased by a mean gain of 91 and 61, respectively (Po0:05). The radioscaphoid angle and the carpal height ratio were not significantly changed, and only minimal deterioration of degenerative change was observed. The size, density or location of the inserted bone did not change with time. Discussion: Vascularized pronator quadratus-enveloped radial bone flap arthroplasty is a reliable treatment for advanced Kienbo¨ck’s disease, with its pedicled bone and muscle envelope acting as a stable spacer for the removed lunate. 10.1016/j.jhsb.2006.03.085
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
7.7 COMPARISION OF LICHTMAN STAGING WITH RADIOLOGIC ANALYSIS OF KIENBOCK’S DISEASE
H. Bhansali, I. Trail and M. J. Hayton Wrightington Hospital, Wigan, UK Background: Lichtman staging is widely used in the classification of Kienbock’s disease. However the differentiation between various stages can be subjective and thus may affect the choice of treatment modality. Aims: To compare the range of carpal height ratio with Lichtman staging and suitability of reconstruction in Kienbock’s disease. Patients and methods: Two Consultant upper limb surgeons independently graded according to Lichtman’s staging 50 plain AP and lateral radiographs of patients with Kienbock’s disease. It was also determined whether radiologically it was suitable for a reconstructive procedure or salvage. These X-rays were then separately analysed by an independent observer for carpal height ratio using two different methods – standard carpal height ratio (Youm et al.) and revised carpal height ratio (Nattrass et al.) and carpal collapse by capitate–radius distance. The Lichtman staging and suitability for reconstruction or not was then compared against the carpal height measurement. Results: The average carpal height ratio in the X-rays with Lichtman stage 2 was 1.49 (range, 1.4–2.5), for stage 3A was 1.43 (range, 1.33–1.59), for stage 3B (reconstructible group) was 1.40 (range, 1.31–1.43) while those X-rays with stage 3B unreconstructible group had a significantly lower mean carpal height ratio of 1.34 (range, 1.15–1.39) (Po0:001). Conclusion: We conclude that Lichtman stage 2, 3A & 3B with average carpal height ratio of between 1.35 and 1.4 and above are suitable for reconstruction. 10.1016/j.jhsb.2006.03.086
7.8 PYROCARBON A.P.S.I PROSTHESIS IN KIENBOCK’S DISEASE
C. Grandis, G. F. Berzero and M. Pasqualini Istituto Ortopedico Galeazzi, Milano, Italy Purpose: To replace lunate bone affected with avascular necrosis (Kienbock’s disease) A.P.S.I. pyrocarbon prosthesis was inserted in 12 cases operated on from 2000 to 2005. Patients and methods: Eight patients with lunate necrosis were belonging to the stage 2 by Lichtman, 3 to the stage 3A, 1 case regarded the replacement of an old implanted Swanson type silicone rubber prosthesis. Patients were five females and seven males with an average age of 31 (23–42); six right hands (all right-handed patients), four left hands (two right and left-handed) and one patient
flexion–extension and radial–ulnar motion recovered respectively 94% and 92% of the contralateral side. Grip strength was 99% compared to the opposite side. All patients, except one (complaining of soreness after exertion), were satisfied. There were no complications. Conclusions: Our results are in agreement with recent literature on acute percutaneous fixation of scaphoid fractures. The Twin-Fixtscrew has always achieved stable fixation allowing consolidation with early return to job or sport activity. 10.1016/j.jhsb.2006.03.084
7.6 VASCULARIZED PRONATOR QUADRATUS-ENVELOPED RADIAL BONE FLAP ARTHROPLASTY FOR ADVANCED KIENBO¨CK’S DISEASE
G. H. Baek, M. S. Chung, H. S. Gong, Y. H. Lee, J. K. Kim and S. K. Lee Seoul National University College of Medicine, Korea Background: There has been no general agreement for the treatment of advanced Kienbo¨ck’s disease. Since 1982, we performed a kind of lunate replacement arthroplasty, which includes excision of the lunate and insertion of a vascularized pronator quadratus-enveloped radial bone flap, for the stage IIIB or IV Kienbo¨ck’s disease. Aim: We present our procedure and the outcome of 41 patients who were followed-up for more than 3 years postoperatively. Patients and methods: Forty-eight patients were treated by our method. Seven patients were lost to follow-up, and 41 patients came to the hospital for direct examinations and were included in this study. The mean age at the time of their operation averaged 39 (range, 19–58) years. Thirteen of them were stage IIIB and 28 were stage IV. The duration of follow-up averaged 6.1 (range, 3–22) years. Results: All patients reported improvement of their symptoms and 20 out of 41 patients became painless after the operation. Postoperative extension and flexion of the wrist were increased by a mean gain of 91 and 61, respectively (Po0:05). The radioscaphoid angle and the carpal height ratio were not significantly changed, and only minimal deterioration of degenerative change was observed. The size, density or location of the inserted bone did not change with time. Discussion: Vascularized pronator quadratus-enveloped radial bone flap arthroplasty is a reliable treatment for advanced Kienbo¨ck’s disease, with its pedicled bone and muscle envelope acting as a stable spacer for the removed lunate. 10.1016/j.jhsb.2006.03.085
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
7.7 COMPARISION OF LICHTMAN STAGING WITH RADIOLOGIC ANALYSIS OF KIENBOCK’S DISEASE
H. Bhansali, I. Trail and M. J. Hayton Wrightington Hospital, Wigan, UK Background: Lichtman staging is widely used in the classification of Kienbock’s disease. However the differentiation between various stages can be subjective and thus may affect the choice of treatment modality. Aims: To compare the range of carpal height ratio with Lichtman staging and suitability of reconstruction in Kienbock’s disease. Patients and methods: Two Consultant upper limb surgeons independently graded according to Lichtman’s staging 50 plain AP and lateral radiographs of patients with Kienbock’s disease. It was also determined whether radiologically it was suitable for a reconstructive procedure or salvage. These X-rays were then separately analysed by an independent observer for carpal height ratio using two different methods – standard carpal height ratio (Youm et al.) and revised carpal height ratio (Nattrass et al.) and carpal collapse by capitate–radius distance. The Lichtman staging and suitability for reconstruction or not was then compared against the carpal height measurement. Results: The average carpal height ratio in the X-rays with Lichtman stage 2 was 1.49 (range, 1.4–2.5), for stage 3A was 1.43 (range, 1.33–1.59), for stage 3B (reconstructible group) was 1.40 (range, 1.31–1.43) while those X-rays with stage 3B unreconstructible group had a significantly lower mean carpal height ratio of 1.34 (range, 1.15–1.39) (Po0:001). Conclusion: We conclude that Lichtman stage 2, 3A & 3B with average carpal height ratio of between 1.35 and 1.4 and above are suitable for reconstruction. 10.1016/j.jhsb.2006.03.086
7.8 PYROCARBON A.P.S.I PROSTHESIS IN KIENBOCK’S DISEASE
C. Grandis, G. F. Berzero and M. Pasqualini Istituto Ortopedico Galeazzi, Milano, Italy Purpose: To replace lunate bone affected with avascular necrosis (Kienbock’s disease) A.P.S.I. pyrocarbon prosthesis was inserted in 12 cases operated on from 2000 to 2005. Patients and methods: Eight patients with lunate necrosis were belonging to the stage 2 by Lichtman, 3 to the stage 3A, 1 case regarded the replacement of an old implanted Swanson type silicone rubber prosthesis. Patients were five females and seven males with an average age of 31 (23–42); six right hands (all right-handed patients), four left hands (two right and left-handed) and one patient