title: Comparison of clinical and radiologic treatment outcomes of Kienböck's disease.
abstract: OBJECTIVE
  The clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck's disease (KD) progression exists.
  
  
  METHODS
  Out of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups.
  
  
  RESULTS
  There were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant.
  
  
  CONCLUSIONS
  The study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease.
  
  
  METHODS
  Therapy, level III, retrospective comparative study with prospectively collected data.
authors: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany. stephane.stahl@gmail.com.
authors: Stéphane
authors: S
authors: Stahl
authors: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany. phentschel@bgu-tuebingen.de.
authors: Pascal J H
authors: PJ
authors: Hentschel
authors: Department for Plastic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany. ade.sstahl@gmail.com.
authors: Adelana
authors: A
authors: Santos Stahl
authors: Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University of Tübingen, Silcherstr. 5, 9572076, Tübingen, Germany. christoph.meisner@med.uni-tuebingen.de.
authors: Christoph
authors: C
authors: Meisner
authors: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany. hschaller@bgu-tuebingen.de.
authors: Hans-Eberhard
authors: HE
authors: Schaller
authors: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany. tmanoli@bgu-tuebingen.de.
authors: Theodora
authors: T
authors: Manoli
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D010027:Osteotomy / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome