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45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC)

11.09. - 13.09.2014, München

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Comparative study on clinical and radiological treatment outcome with prospectively collected data of 57 cases of Kienböck’s disease

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  • presenting/speaker Stéphane Stahl - Tübingen, Deutschland
  • Pascal J. H. Hentschel - BGU Tübingen, Klinik für Hand-, plastische, rekonstruktive und Verbrennungschirurgie, Tübingen, Deutschland
  • Hans-Eberhard Schaller - Tübingen, Deutschland

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. Österreichische Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie. 45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPRÄC). München, 11.-13.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc238

doi: 10.3205/14dgpraec071, urn:nbn:de:0183-14dgpraec0716

Published: September 3, 2014

© 2014 Stahl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objectives: We compared the functional outcomes of scaphotrapeziotrapezoid (STT) arthrodesis and radial shortening osteotomy (RSO) and evaluated the impact of RSO or vascularized bone grafts (VBG) on disease progression.

Methods: Out of ninety eight consecutive patients treated between 1991 and 2013, 57 patients were enrolled in a retrospective comparative study. The 2 largest treatment groups were compared regarding post-operative range of motion (ROM), visual analog scale pain score (VAS), grip strength, duration of incapacity for work and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Radiographic assessment (Nattrass index, radioscaphoid angle and Ståhl index) was performed to determine disease progression after RSO or VBG or both.

Results: The patient-based outcome ratings were comparable in all treatment groups. There was no significant difference in post-operative ROM (p = 0.115), wrist pain (p = 0.386), grip strength (p = 0.806), duration of incapacity (p = 0.134) and DASH score (p = 0.505) after STT arthrodesis (n=27) or RSO (n=14). After RSO the Nattrass index, the radioscaphoid angle and the Ståhl index suggested disease progression although the changes were not significant (p = 0.376; p = 1.000; p = 0.706 respectively). No evidence of cured osteonecrosis was found after decompression or revascularization or both.

Conclusions: The study failed to demonstrate predicted clinical relevant differences between STT arthrodesis and RSO. No evidence was found that either RSO or VBG or the combination of the two can reverse or halt the course of the disease.