gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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A new combined treatment for Kienböck's disease: bone leveling procedure with bone marrow mesenchymal stem cell administration

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  • presenting/speaker Ireneusz Walaszek - Department of Orthopeadics, Traumatology and Oncology, Pomeranian Medical University, Szczecin, Poland
  • Agnieszka Dabek-Szwajlik - Department of Orthopeadics, Traumatology and Oncology, Pomeranian Medical University, Szczecin, Poland
  • Elzbieta Gawrych - Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
  • Justyna Rajewska-Majchrzak - Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
  • Milosz Parczewski - Department of Infectious, Tropical Diseases, and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
  • Kaja Gizewska-Kacprzak - Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University, Szczecin, Poland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1112

doi: 10.3205/19ifssh1130, urn:nbn:de:0183-19ifssh11300

Published: February 6, 2020

© 2020 Walaszek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Avascular necrosis of the lunate bone (Kienböck's disease) is a rare entity that leads to a significant hand dysfunction. Treatment algorithms are variable up to radical salvage procedures. The aim of this study was to analyse the results of a treatment combining surgical bone leveling intervention with autologous stem cell administration.

Methods: Nine consecutive patients with advanced Kienbock disease underwent treatment with surgical osteotomies and direct injections of bone marrow concentrate to the lunate bone. Individually regarding anatomical prerequisites certain surgical techniques were applied, as radial shortening in the ulnar positive variance and capitate shortening in the ulnar neutral variance. The patients were examined prior and after surgery using the Visual Analog Pain Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire supplemented with an assessment of the active range of motion (AROM) and the grip strength. An X-ray evaluation was compared with the preoperative findings.

Results and Conclusions: Preoperative hand function was impaired in all of the patients (median DASH: 27, with 56% of grip strength and 60% of AROM compared to the unaffected side). The preoperative pain was extensive (median VAS: 7). Following the presented combined interventions, a significant decrease in DASH score (median: 12, p = 0.0077), a reduction of pain (median VAS: 2, p = 0.0076) and an increase in grip strength (median: 61%, p = 0.007) were observed.

The study provides a protocol for combining bone leveling procedures with a direct administration of bone marrow cells in the treatment of avascular necrosis of the lunate bone that could be easily implemented in surgical practice.

The combined treatment method has promising results as the improvement of hand function and the decrease in pain.

The suggested technique can protect patients with Kienbock disease from salvage procedures with a restricted range of motion of the wrist.