Kienbock young woman (IWAS Clinical case)
What would you do for this 22 yo woman who already tried conservative treatment for 1,5 year.
Thanks a lot
Nice congress to those who come to Paris!
Dr Violaine BEAUTHIER-LANDAUER
Dear Dr Beauthier Landauer,
Thank you for this nice case. I hope there will be an interesting discussion about it! Clinically, is the stiffness painful? What is the major complain?
As you mentioned, it does not look like there is any osteoarthritis on the adjacent joints and it doesn’t looks as there were any carpal misalignment (It would be nice to determine this on the lateral-Rx views). The CT scan does not show major lunate defragmentation.
Radius shortening is probably the most classical procedure in this case.
PS: her left ulnar styloid looks tricky on x-rays and CT)
Dr. Camilo CHAVES
I would suggest arthroscopic staging and then almost certainly radial shortening with 1 or 2mm. I use a 5 hole volar plate (ulnar shortening version with locking screws proximal and distal) and oblique osteotomy. You can mobilize the patient immediately. It is is my experience that the patient gets painfree as soon as the postoperative caused discomfort disappears.
I would first scope the wrist. Assumed that the cartilage surfaces were intact, I would go for a lunate revascularization procedure: 4/5 EKA bone graft from the distal radius.
Best regards from Switzerland
this case could be treated with a Camembert osteotomy...
with or without filling the lunate.
My opinion is that an osteotomy does not heal the bone, only protects it from collapse, until lunate heals by creeping substitution...
for me the best protective osteotomy is Camembert. E. Camus
For it is ideal case for vascularised femoral condyle graft
for proximal half of lunate.
This is only one chance to restore full wrist function.
For me excellent indication of my technique
1/ arthroscopic checking of safety of cartilage
2/ Radius shortening
3/ revascularization of lunatum
PJ in copy my paper published…10 years ago
Pr. Christophe MATHOULIN
Hello, in my experience radial shortening is effective to relieves pain. No reasons to have ulnar pain after, she has a real long radius no abnormal slope of the DRUJ. I ‘ll propose arthroscopic procedure if there is no long radius . A little too young for PRC? Good luck Erle Weltzer
I agree fully with Giuseppe Broccoli. If the cartilage is not intact, I would go for PRC, in case of cartilage damage in the fossa lunata perhaps with capsular interposition or fusion S-C. (Or denervation)
thanks for this great case
I would also recommend that you look to scope and stage, it provided the best appreciation of the articular involvement
For the shortening, we have moved to the “Single cut osteotomy"
This has the advantage, of being a simple procedure, the periosteum is not divided, to it remains essentially stable,
It only requires a single screw, and no need for plasters, only a removable splint