Long-Term Results of Surgery for Kienbock's Wrist Disease
It's hard to get a handle on how to treat rare diseases. Kienbock's disease of the wrist is one of those conditions. The lunate bone in the wrist falls apart because of a lack of blood supply. The cause is unclear. But the results are pain, loss of motion, and reduced function.
By keeping track of patients' results after various treatment methods, doctors bring new information to the clinic. In this study, doctors in Japan followed 25 patients for up to 15 years after surgery. During surgery the doctors removed a piece of bone from the end of the radial bone in the forearm. This is done when the end of the radius is pressing on the lunate. The operation is called a radial osteotomy.
The authors of this study say shortening the radius is a reasonable treatment method for Kienbock's disease. Improved motion and function last a long time. X-rays didn't show much change, but new test measures showed improved blood flow to the lunate. They found a better way to measure these changes using the standard X-rays. They made up a new grading system to rate improvement in the lunate bone. The grading system looked at the height of the bone, bone density, and the space between the bones. The researchers think the radial osteotomy resulted in slow but steady improvement to the inner structure of the lunate.
Overall results showed pain, motion, and grip strength were much better after surgery. The results lasted five, 10, even 15 years for most of the patients. The biggest problem after radial osteotomy for these patients was the onset of osteoarthritis (OA). Even with OA, however, symptoms and use of the wrist and hand remained improved. In other words, patients didn't seem too bothered by the arthritis.
Shukuki Koh, MD, et al. Surgical Outcome of Radial Osteotomy for Kienbock's Disease-- Minimum 10 Years of Follow-Up. In The Journal of Hand Surgery. November 2003. Vol. 28A. No. 6. Pp. 910-916.