Efficiency of concentrated bone marrow aspirate combination with temporary fixation of the scaphoid-trapezius-trapezoidal joint in Kienbeck’s disease

Authors

  • Sergey Tymochenko
  • Igor Gajovich
  • Sаmir Аbbasov
  • Аndrij Lysak

DOI:

https://doi.org/10.15674/0030-59872020443-48

Keywords:

Bone marrow aspirate concentrate, lunate bone, radiography, joint instability, bone remodeling, osteonecrosis

Abstract

Method of concentrated bone marrow aspirate (BMAC) injection into aseptic bone necrosis of different localizations are described in the literature, however, without demonstrating structural and functional results for Kienbeck’s disease. Objective. To establish functional and radiological changes at injection of concentrated bone marrow aspirate into lunate bone in combination with scaphoid-trapezoid-trapezius joint temporary fixation in patients with idiopathic lunate bone necrosis. Methods. The procedure was performed in 11 patients. Age 18–46 years (28,9 ± 9,5) 6 women, 5 males. Kienbeck's disease stage II — 4 patients, IIIa — in 2, IIIb in 5 patients. Bone marrow aspirate concentration from the ili­ac bone was obtained using Arthrex-Angel technique, injection of 2–3 ml of the concentrate with intraosseous needle under X-ray control into the focus of aseptic necrosis of the lunate bone, STT-fixation of the wrist joint in the position of rotational correction of the scaphoid. Immobilization followed for 2 months, than remo­val of the K-wires and rehabilitation. X-ray, CT control and DASH testing before the procedure and in a year. Results. Five patients (45 %) had a distinct positive clinical and radiological dynamics, definite positive changes on CT (pathological fracture consolidation, lunate bone remodeling), as well as DASH scale improvement, maintenance of wrist joint radiometric parameters and an increase in strength and range of motions in the wrist. Four patients had no significant dynamics, and in two patients there was a distinct decline in function, advance lunate bone destruction, and an increased wrist joint instability. Conclusions. The technique requires advance revision of the conditions under which it demonstrates its effectiveness. Today it can be recommended in addition to other surgical procedures (shortening of the radius, STT arthrodesis), which have more predicted effectiveness.

Author Biographies

Sergey Tymochenko

 SI «Institute of traumatology and orthopedics of National Academy of Medical Sciences of Ukraine», Kyiv

PhD

Igor Gajovich

SI «Institute of traumatology and orthopedics of National Academy of Medical Sciences of Ukraine», Kyiv

PhD

Sаmir Аbbasov

«Center of Scientific Surgery named after Academician Topchubashov», Baku. Azerbaijan

Аndrij Lysak

SI «Institute of traumatology and orthopedics of National Academy of Medical Sciences of Ukraine», Kyiv

References

Grigorovsky, V. V., Strafun, S. S., & Tymoshenko, S. V. (2013). Histopathology and morphometric parameters of the tissues of the wrist joint in the case of ischemic osteonecrosis of the crescent bone of the wrist (Kinbeck's disease). Orthopedics, traumatology and prosthetics, 1, 60-66. https://doi.org/10.15674/0030-59872013160-66. [in Ukrainian]

Ogawa, T., Ochiai, N., Tanaka, T., Hara, Y., & Nishiura, Y. (2013). A new treatment strategy for Kienböck’s disease: Combination of bone marrow transfusion, low-intensity pulsed ultrasound therapy, and external fixation. Journal of Orthopaedic Science, 18(2), 230-237. https://doi.org/10.1007/s00776-012-0332-7

Ikeguchi, R., Aoyama, T., Kakinoki, R., Ueda, M., Kasai, Y., Maekawa, T., … & Toguchida, J. (2019). A clinical trial for Kienböck disease by cultured autologous multipotent mesenchymal stromal cells augmented with vascularized bone grafts: A report of five cases. Journal of Orthopaedic Science, 24(4), 750-756. https://doi.org/10.1016/j.jos.2017.02.002

Arbeloa-Gutierrez, L., Dean, C. S., Chahla, J., & Pascual-Garrido, C. (2016). Core decompression augmented with autologous bone marrow aspiration concentrate for early avascular necrosis of the femoral head. Arthroscopy Techniques, 5(3), e615-e620. https://doi.org/10.1016/j.eats.2016.02.009

Lichtman, D. M., Alexander, A. H., Mack, G. R., & Gunther, S. F. (1982). Kienböck's disease—Update on silicone replacement arthroplasty. The Journal of Hand Surgery, 7(4), 343-347. https://doi.org/10.1016/s0363-5023(82)80142-1

Hudak, P. L., Amadio, P. C., Bombardier, C., Beaton, D., Cole, D., Davis, A., … & Wright, J. (1996). Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and head). American Journal of Industrial Medicine, 29(6), 602-608. https://doi.org/10.1002/(sici)1097-0274(199606)29:6<602::aid-ajim4>3.0.co;2-l

Mann, F. A., Wilson, A. J., & Gilula, L. A. (1992). Radiographic evaluation of the wrist: What does the hand surgeon want to know? Radiology, 184(1), 15-24. https://doi.org/10.1148/radiology.184.1.1609073

Issue

Section

ORIGINAL ARTICLES