title: A new treatment strategy for Kienböck's disease: combination of bone marrow transfusion, low-intensity pulsed ultrasound therapy, and external fixation.
abstract: BACKGROUND
  The purpose of this study was to investigate the midterm clinical and radiographic outcomes of this new treatment for Kienböck's disease.
  
  
  METHODS
  We applied a new method involving drilling, bone marrow transfusion, external fixation, and low-intensity pulsed ultrasound for patients with Kienböck's disease. Between 2000 and 2006, the treatment was performed in 18 patients (10 men and 8 women; 9 right wrists and 9 left wrists). The preoperative Lichtman stages were stage II in 4 cases, stage IIIa in 11 cases, and stage IIIb in 3 cases. The mean age at surgery was 44.9 years (range 16-68 years), and the mean follow-up period was 63 months (range 28-125 months). The overall results were evaluated using the Mayo wrist score and Nakamura scoring system for Kienböck's disease. Magnetic resonance imaging (MRI) was performed for all patients.
  
  
  RESULTS
  Wrist pain improved to no pain in 13 patients, mild pain in 4 patients, and moderate pain in 1 patient. The average wrist flexion-extension arc was 100° and averaged 120 % of the preoperative value. The average grip strength increased from 50 to 85 % relative to the unaffected side. On roentgenograms, the carpal height ratio (change from 0.53 to 0.51) and the Stahl index (change from 0.38 to 0.32) decreased slightly. On MRI, fatty marrow was recovered in 11 patients (61 %) on proton density-weighted images.
  
  
  CONCLUSIONS
  This method can be used as a less-invasive surgical treatment alternative for Kienböck's disease. At an average follow-up period of 6 years, this new treatment has been shown to be a reliable and durable procedure for patients with Lichtman stage II or stage III Kienböck's disease. Caution should be exercised for patients with a fragmented lunate because of the risk of collapse and nonunion of the lunate.
authors.affiliation: Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba 278-0005, Japan. oga-take@pg7.so-net.ne.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Ochiai
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Nishiura
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D016267:External Fixators; D005260:Female; D018737:Hand Strength; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000473:pathology / Q000628:therapy*; D010147:Pain Measurement; D016896:Treatment Outcome; D014464:Ultrasonic Therapy