Free Vascularized Iliac Bone Promising Treatment Option for Kienbock's Disease Stage 3Kienbock's disease, a disorder that restricts blood flow to one of the small bones in the hand near the wrist, causes osteonecrosis, or bone death, to the bone. Doctors don't know what causes Kienbock's disease but there are some treatment options available.
In the early stages of the disease, doctors might reconstruct the bony area to bring blood to the bone, for example. The authors of this study were interested in evaluating the long-term outcome of a procedure called grafting, where vascularized bone (grown bone) from the pelvic area is used to graft to the affected bone in the hand.
Currently, there are data that show up to five years of follow up following this type of graft surgery, but these researchers wanted to know the longer 10-year outcome. In order to do this, the researchers found 18 patients with Kienbock's disease stage 3 who had undergone this surgery. None of the patients had received any other type of treatment for this disorder. X-rays taken before the surgery showed no signs of osteoarthritis.
The patients were all assessed before and after surgery by x-ray and for their active range of motion and ability to use their hand. Pain was assessed using the Visual Analog Scale (VAS). Patients rate their pain on the VAS from zero to 100, with 100 being the most severe possible. The patients' function after the surgery was measured using the DASH questionnaire, from zero to 100, with 100 being the worst outcome.
At five years after the surgery, 16 patients' hands had responded to the graft but two had not. Their grafts had fractured and were no longer in place. The x-rays of the 16 successful wrists showed that the bones had integrated successfully at five years and at 10 years as well. Their range of motion and grip strength remained better at 10 years than they had been before the surgery.
Pain, as assessed by the VAS, decreased from between 35 and 85 points to 0 to 15 points at the five-year follow up. At 13-year follow up, pain was reported at 0 to 19 points. The researchers found that one patient did experience mild pain at the final follow up, despite having no pain at five years.
In reviewing the findings from the two patients whose grafts did not succeed, the researchers found that there was statistical worsening of active range-of-motion and strength between the five-year follow up and the final follow up.
Complications only occurred in two patients (infection).
The authors concluded that study findings showed the good functional, radiologic, and subjective outcome of this grafting technique. The authors wrote, "This graft has been found to be strong enough to carry the applied loads for a long period of time." They suggest that the grafting is a reasonable treatment option for patients with Kienbock's disease stage 3.
Rohit Arora, MD, et al. Long-Term Subjective and Radiological Outcome After Reconstruction of Kienbock's Disease Stage 3 Treated by a Free Vascularized Iliac Bone Graft. Journal of Hand Surgery. February 2008. Vol. 33. No 2. Pp. 175-181.
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