Study: Kienböck’s disease may progress to fragmentation within 6 months

BOSTON — Research presented here sheds new light on the natural evolution and features of Kienböck’s disease.

“Short histories of pain were associated with significantly fewer pathognomonic parameters, increasing the risk of false positive diagnosis in early stages,” Stéphane Stahl, MD, said during his presentation at the American Society for Surgery of the Hand Annual Meeting. “No specific combination or sequence of radiologic parameters were specific to the natural evolution of the disease. Therefore, we question the validity and prognostic value of current classifications. Kienböck’s disease may progress to fragmentation within only 6 months.”

Stéphane Stahl

Stahl presented the results of two studies performed to determine the frequency and distribution of radiographic and clinical signs of the disease and to determine the correlation of diagnostic parameters with patients’ onset of symptoms. With approval of an ethics review board, Stahl conducted a 5-year prospective study of 26 patients with complete case report forms that included information from a clinical examination, a medical record evaluation and a self-assessment questionnaire. X-ray, MRI and CT scans of the patients were evaluated by a board-certified radiologist and hand surgeon. Some of the diagnostic parameters studied included arthritis, sclerosis of the lunate on CT, deformity of the lunate on X-ray and fractures of the lunate.

“We found out that the number of radiologic parameters assessed correlates or increases as the duration of the disease increases,” Stahl said. “We were surprised to see that looking at each individual radiologic parameter, the lapse of time which could be assessed since the beginning of the disease did not significantly differ from one another, except for arthritis of the scaphoid fossa. We were also surprised to see that one-third of the patients had arthritis of the lunate, but no fractures or no sign of carpal collapse.”

To determine the timeline for the evolution of Kienböck’s disease, Stahl performed a retrospective review of data for the 106 patients with the disease who were treated at his institution from 1990 to 2014 and only looked at those patients who had no surgery until fragmentation of the lunate. Of the three patients identified, Stahl said the diseased evolved to fragmentation within 6 months. – by Gina Brockenbrough, MA

Reference:

Stahl S. Paper #5. Presented at the: American Society for Surgery of the Hand; Sept. 18-20, 2014; Boston.

Disclosure: Stahl has no relevant financial disclosures.