Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years.

We inserted a pronator quadratus pedicled bone graft into the avascular lunate with preservation of its corticocartilaginous portion for the treatment of Kienböck disease. Twenty-seven patients (14 men, 13 women; mean age, 42 years (range 17-66 years)) were treated between September 2005 and July 2014 and followed up from 2 to 12 years. Three patients had Lichtman stage II disease, 13 had stage IIIA, and 11 had stage IIIB. Among them, 18 patients showed radiological improvement in lunate morphology. The Lichtman stage was unchanged in 23 patients and aggravated in four patients. The Stahl index was significantly decreased, but grip strength was significantly improved and 18 patients did not have any wrist pain during daily activities. Although our technique did not restore the already changed carpal malalignment, it improved lunate morphology. Clinically, it provided satisfactory pain levels in two-thirds of the patients and grip strength was improved. Level of evidence: IV.

Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review.

BACKGROUND: Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease. METHODS: We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies. RESULTS: Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°). CONCLUSIONS: Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Penetration depth and size of the nonarthritic glenoid: implications for glenoid replacement.

Shoulder arthroplasty is technically demanding and relies heavily on precise surgical technique and preoperative planning. Proper glenoid component sizing plays a crucial role for successful shoulder arthroplasty. In this study, we measured the glenoid size together with penetration depth using three-dimensional computed tomography (3D-CT). From January 2010 to January 2011, 38 patients, including males and females, without evidence of a pathological glenoid, were enrolled for this study. CT images were taken and subsequently reconstructed in 3D images. The height of the glenoid was measured and the width was measured at five different levels (H1-H5). Axial images were taken at each level, with the anteroposterior (AP) glenoid diameter divided into eight areas (W1-W7). The penetration depth between the near and far cortices (thickness) at points W1-W7 was also measured. The overall mean height of the glenoid was 37.67 ± 4.09 mm. The width of the glenoid was the greatest at the distal 4/5th point and it was the least at the proximal 1/5th point. The penetration depth of the glenoid increased as the reference point progressed in the posterior direction, which was at the 5/7th point from the anterior margin. The measurement was greatest at the W4 point at the H1 level, but the W5 point was greatest at all other levels. On the basis of this study, the posterior and inferior parts of the glenoid are thinner than the anterior and superior parts. Thus, caution must be taken when inserting screws into the posteroinferior parts, where the glenoid is thinner than 15 mm, especially in females, to avoid penetration of the far cortex.