Indian J Orthop. 2009 Apr;43(2):189-93. doi: 10.4103/0019-5413.50854.

Distraction histiogenesis for treatment of Kienbock's disease: A 2- to 8-year follow-up.

Indian journal of orthopaedics

Ds Meena, Narender Saini, Vishal Kundanani, Lokesh Chaudhary, Dinesh Meena

PMID: 19838369 PMCID: PMC2762252 DOI: 10.4103/0019-5413.50854

Abstract

BACKGROUND: Distraction histiogenesis is known to enhance vascularity and stimulate new tissue formation. Its use in Kienbock's disease is not reported in the literature, so we proposed to study the outcome after distraction histiogenesis in treating this condition.

MATERIALS AND METHODS: This prospective study comprised of six patients (two male and four female) with mean age 18.16 years (range 21-35 years) with clinicoradiologically diagnosed Lichtman stage II (n = 3) and stage III (n = 3) Kienbock's disease with a mean duration of symptoms 6.67 months. The ulnar variance was neutral in two and was negative in four patients treated with the application of Joshi external stabilization system (JESS) across the wrist. The gradual distraction was done at a rate of 0.5 mm/day. After the distraction of 5-7 mm, the distractors were kept static for 3 weeks. The wrist was mobilized by using hinged distractors for next 3 weeks. Later short cockup splint was used for further 4 weeks. At the end of minimum 2 years, an assessment was done on the basis of relief of symptoms, ability to perform activities of daily living, range of movement at wrist, grip strength, and on radiology (change in the density of bone and C:MC ratio i.e ratio of carpal height to third metacarpal height).

RESULTS: The mean follow-up was of 4.5 years (range 2-8 years). The average duration of treatment was 5.3 months (range 4.5-6 months), and the duration of distraction (both static and hinged) was 8 weeks. Clinically all the patients were relieved of the symptoms with an increase in the range of wrist movement (ulnar deviation increased from 20.8 degrees to 29.5 degrees , radial deviation from 17.5 degrees to 21 degrees , dorsiflexion from 37.5 degrees to 52.5 degrees , and palmer flexion from 38.3 degrees to 47.5 degrees ). At the last follow-up, activities of daily living were not affected, and all the patients were on their previous jobs without any fresh complaints. The average grip strength increased to 73-86% of normal. Radiologically the C:MC ratio (ratio of carpal height to third metacarpal height) did not show any significant improvement, but the density of lunate decreased.

CONCLUSION: Distraction histiogenesis when used in Lichtman stage II and III with negative or neutral ulnar variance gives good symptomatic relief, allowing return to normal activities. This study has also shown that reparative process is possible in avascular bone by distraction. The authors recommend further research in this modality of treatment.

Keywords: Distraction histiogenesis; Kienbock's disease; wrist pain

References

1. J Hand Surg Br. 1992 Feb;17(1):3-4 - PubMed
2. J Bone Joint Surg Am. 1991 Oct;73(9):1391-6 - PubMed
3. J Pediatr Orthop B. 2004 Sep;13(5):345 - PubMed
4. Acta Orthop Scand. 1987 Jun;58(3):241-3 - PubMed
5. Acta Orthop Belg. 1994;60(1):1-9 - PubMed
6. J Hand Surg Br. 1998 Feb;23(1):33-6 - PubMed
7. J Hand Surg Am. 1996 Jan;21(1):9-15 - PubMed
8. Hand Clin. 1993 Aug;9(3):409-16 - PubMed
9. J Bone Joint Surg Br. 2004 Mar;86(2):244-50 - PubMed
10. J Hand Surg Am. 1995 Nov;20(6):902-14 - PubMed
11. J Hand Surg Am. 1994 Nov;19(6):1016-8 - PubMed
12. J Hand Surg Am. 1982 Jul;7(4):343-7 - PubMed
13. Acta Orthop Scand. 1968;39(3):359-69 - PubMed
14. J Hand Surg Am. 1982 Jul;7(4):348-52 - PubMed
15. J Pediatr Orthop B. 2004 May;13(3):158-65 - PubMed
16. J Hand Surg Am. 1980 May;5(3):272-8 - PubMed

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