Description
In this presentation, Dr. Émile Hashem, a resident at the University of Western Ontario, discusses Kienbock's Disease, a serious condition characterized by the progressive avascular necrosis of the lunate bone in the wrist. This results in significant wrist pain and abnormal carpal motion. The presentation highlights the multifactorial etiology of the disease, including biomechanical factors, trauma, and anatomical variations, and emphasizes the importance of the Lichtman classification system for categorizing the stages of Kienbock's Disease.
Dr. Hashem details a study conducted at a high-volume hand and wrist surgical center, which aims to evaluate the long-term outcomes of surgical interventions for Kienbock patients. He outlines the methods of the study, including a retrospective review of 47 patients, leading to 26 agreed in-person follow-ups despite some patients being lost to follow-up due to mortality or refusal. The study focuses on various outcome measures such as patient-reported evaluations, grip strength, and complications among the surgical procedures performed.
Results show that the majority of procedures performed were radial shortening osteotomies, which yielded the highest patient satisfaction and maintained better range of motion. The findings also include a comparison of outcomes among patients with different stages of the disease, revealing that radial shortening osteotomy consistently resulted in superior outcomes compared to proximal row carpectomy and arthrodesis in terms of pain and disability measures.
The complications observed, such as complex regional pain syndrome, were noted to occur primarily in patients who underwent proximal row carpectomy. Dr. Hashem concludes with a recognition of the limitations of the study, particularly the small sample size and the interruptions caused by COVID-19, and calls for collaboration with other Canadian surgical centers to enhance the research scope and validity of future findings on surgical management of Kienbock's Disease.