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Easing Pressure on Hand Bone in People with Kienbock's Disease Appears Effective for Some Patients

Kienbock's disease is a disease that affects the blood flow to a small bone in the hand, called the lunate. If the blood supply is cut off completely, the bone dies. Patients with Kienbock's disease often need to have surgery. The success rates for the various surgeries range from 55 percent to 88 percent. Because different surgeries have been tried with varying success, the authors of this study wanted to see if a procedure called the distal radius shortening osteotomy would provide good long-term outcomes. This procedure involves shortening the bone in the arm (the radius) and relieves pressure on the lunate.

The researchers performed 13 procedures in 12 patients, who were an average of 31 years old (ranging from 20 to 44 years). Nine patients were available for follow-up for an average of 22 years, ranging from 16 to 31 years. To assess the surgery's outcome, the patients used the Visual Analog Scale (VAS), which rates pain on a level from 0 to 10, with 10 being the worst. The researchers used the Disabilities of the Arm, Shoulder, and Hand (DASH) scores; DASH scores are from 0 to 100, with 100 being the worst possible outcome. The patients' wrists were measured for range of motion and grip strength; x-rays were also taken.

The findings showed after the surgery, the average VAS score for pain was 2.4 (responses ranged from 1 to 10) and for satisfaction at 2.2 (responses ranged from 0 to 8). The DASH score average was 14, with a range of 0 to 68. Of the nine patients available for follow up, 8 were able to return to work. The range of motion on the affected hands was still less than that of the other hand, as was the grip strength.

The authors point out that their study was very small with limited follow up, so they warn that the results may not be generalizable. They note that although the disease did progress in some patients, it appeared to stabilize in all after 10 years.

E.E.J. Raven, MD, D. Haverkamp, MD, PhD, and R.K. Marti, MD, PhD. Outcome of Kienbock's Disease 22 Years after Distal Radius Shortening Osteotomy. In Clinical Orthopedics & Related Research. July 2007. Vol. 460. Pp. 137-141.


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