Radial Shortening for Kienbock Disease Effective for Most PatientsKienbock disease, a disorder where the blood supply fails to reach the small bones in the wrist, causing bone cell death, often feels at first like a sprained wrist. Unfortunately, unlike a sprained wrist, Kienbock disease needs treatment to remove the damaged part of the bone. To do this, surgeons have been performing a procedure called radial osteotomy, where they remove part of the bone.
Three studies have been done looking into the effectiveness of the surgery, but none of the studies looked at the results from the patients' point of view. The studies did conclude that the wrist function was improved following an osteotomy, but the authors of this study wanted to assess how patients evaluated the surgery and its outcome.
The researchers found 19 patients with Kienbock disease who underwent radial osteotomy. The patients who had their surgery before 1981 saw their radius shortened by about four to five millimeters, while those who had their surgery after 1981 only had about two to three millimeters removed.
The patients were sent letters from the researchers that contained the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and questions regrading their satisfaction with the surgery, as well as their current status with the wrist. The DASH questionnaire looks at the ability to perform certain activities with the affected hand and symptoms, scored on a scale from one to five. One meant that the patient had no difficulty performing the activity, while five meant that the patient was unable. The other questions were based on three grades: improved, unchanged, and worse. Pain was assessed with four grades: no pain, occasional mild pain, tolerable moderate pain, and severe to intolerable pain.
Thirteen patients responded to the letter and 12 were examined for wrist range of motion (how many degrees the wrist can move around compared to the normally accepted movement), grip strength in the affected hand, and the wrist score. The patients were rated on a scale of one to 100; 80 to 100: excellent outcome, 65 to 80: good outcome; 50 to 65: moderate outcome; and less than 50 was considered poor outcome. X-rays were also done to assess the bone structure.
The researchers found that 12 of the 13 patients reported after the surgery they had an improvement in pain, 10 reported better range of motion, and 11 better strength. At the current evaluation, seven patients said they had no pain and six had mild pain. Ten patients returned to their previous jobs. None of the patients reported any worsening of pain, range of motion, or strength.
Before surgery, the average range of motion ranged from 20 degrees to 68 degrees, with a mean number of 40, for bending (flexing) the wrist and 30 degrees to 62 degrees, with a mean number of 46, for straightening out the wrist. After the surgery, the mean bending was 58 and the mean extension was 54. Mean grip strength went from 18 kilograms before the surgery to 28 after.
There were some limitations to the study, the authors wrote. These limitations included the fact that this was a retrospective (looking back) study, only 13 patients responded, the small number of patients made it difficult for statistics, and the surgeries were not the same for all patients. However, despite these issues, the authors state that the results of their study backed up the findings of the previous studies, which found that radial shortening osteotomy can provide "reliable, long-term results."
Tadayoshi Watanabe, et al. Long-term Follow-up of Radial Shortening Osteotomy for Kienbock Disease. In Journal of Bone and Joint Surgery. August 2008. vol. 90. Pp. 1705-1711.
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