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Clinical Outcomes of Patients with Stage II and IIIA Kienböck’s Disease After Undergoing Conservative Management

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Abstract

Purpose

The current study aimed to demonstrate the outcomes of patients with Lichtman stage II and IIIA Kienböck’s disease with mild pain and good range of motion (ROM) after conservative management. We hypothesized that we can conservatively manage patients with early-stage Kienböck’s disease including those with stage IIIA.

Patients and Methods

This study is a retrospective case series. Between January 2012 and December 2017, 38 patients were enrolled in this study. The mean follow-up period of conservatively managed group was 49.1 months. The flexion–extension (FE) arc, grip strength, Pain Visual Analog Scale (pVAS), Modified Mayo Wrist Score (MMWS), and disabilities of the arm, shoulder, and hand (DASH) score were determined for functional evaluation. The radiographic parameters were assessed using the Stahl’s index and carpal height ratio. The morphological changes in the lunate were also evaluated with plain radiographs.

Results

A total of 31 of 38 patients (81.6%) showed favorable outcomes after conservative treatment. The mean pVAS score, MMWS, and DASH score showed statistically significant improvement, as well as the morphology of lunates on the plain radiograph. The mean FE arc was slightly decreased without statistical significance. The grip strength showed improvement with statistical significance. One patient showed the same radiographic morphology, but did not manifest any pain. A total of five (13.2%) patients who experienced aggravated pain and decreased ROM underwent surgical treatment. The other patient required surgical intervention but was provided conservative treatment due to her circumstances.

Conclusion

Favorable outcomes can be expected in patients with Lichtman stages II and IIIA avascular necrosis of the lunate (Kienböck’s disease) with mild pain and good ROM who undergo conservative management.

Level of Evidence

IV.

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

The work was performed in the Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Funding

None to declare.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Medical College of Hallym University, Hallym University Sacred Heart Hospital, Chuncheon, 14068, Republic of Korea

    Jae-Hoo Lee & JangWon Son

  2. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea

    Min-Jong Park

Authors
  1. Jae-Hoo Lee
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  2. JangWon Son
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Contributions

J-HL: first author, statistical analysis, radiographic parameters measurement, etc. JWS: co-author, manuscript revision, peer-review. M-JP: corresponding author and the senior surgeon of all surgical treatments, peer-reviewed the paper and revised.

Corresponding author

Correspondence to Min-Jong Park.

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Conflict of Interest

All authors approved the manuscript and all authors declare that are no conflicts of interest regarding the publication.

Ethical Standard Statement

The current study was performed with the approval of our institutional review board (SMC 2020-01-046-003).

Informed Consent

The current study did not required the informed consent, for this study was performed retrospectively with medical records and also did not violated any rights of the participants.

Ethical Review Committee Statement

The current study was performed with the approval of our institutional review board (SMC 2020-01-046-003).

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Lee, JH., Son, J. & Park, MJ. Clinical Outcomes of Patients with Stage II and IIIA Kienböck’s Disease After Undergoing Conservative Management. JOIO 56, 79–86 (2022). https://doi.org/10.1007/s43465-021-00451-0

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  • DOI: https://doi.org/10.1007/s43465-021-00451-0

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