Does the Morphological Type of the Lunate Affect Surgical Outcomes in Patients with Distal Radius Fractures?

Sung-Jae Kim,Koo-Hyun Jung,Hyun-Soo Park,Chang-Hun Lee,Wan-Sun Choi,Kwang-Hyun Lee 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.3

Purpose: We sought to compare the surgical results of distal radius fractures treated with volar locking plate (VLP) between two types of lunate. The hypothesis was that wrists with type II lunate might have worse surgical outcomes of distal radius fracture. Methods: Seventy patients with surgically treated distal radius fracture were included in this study. Morphology of the lunate was analyzed with computed tomography scans and simple radiographs. Patients with type I lunate were defined as having no articulation with the hamate. Patients with type II lunate were defined as having accessory articulation with the hamate. Surgical outcomes were assessed. Range-of-motion (ROM) and grip strength were measured at the final follow-up. All subjects were divided into two groups based on the lunate type and compared. Multiple logistic regression analysis was performed to find predictors for worse surgical outcome. Results: Mean age of the subjects was 53.66 years (17 to 74 years). Mean follow-up was 14.54 months (12 to 52 months). The mean flexion of the wrist joint was significantly lower in the group with type II lunate. The multiple logistic regression analysis demonstrated that the predictors for worse flexion of the wrist joint were patients with type II lunate, and insufficient restoration of normal volar tilt angle at final follow-up. Conclusion: Type II lunate wrist joints had significantly lower ROM, compared with type I lunate wrist joints after surgical treatment of distal radius fracture using VLP.

삼주상 유합술을 이용한 Kienböck 질환의 치료

이재성(Jae Sung Lee),박민종(Min Jong Park),정성모(Sung Mo Jung) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.5

목적: 진행된 Kienbock 질환에서 삼주상 유합술 시 월상골 제거의 필요성과 이의 영향을 알아보고자 하였다. 대상 및 방법: Kienbock 질환(IIIb)으로 삼주상 유합술을 시행받은 환자 중 1년 이상 추시 관찰이 가능한 26명을 대상으로 하였다. 15명은 삼주상 유합술만을, 11명은 월상골의 심한 붕괴로 신전 시 후방 충돌에 의한 운동 제한과 통증이 있어 삼주상 유합술과 함께 윌상골을 제거하였다. 두 군의 임상적 결과는 수술 전후에 완관절 운동 범위, 파악력, modified Mayo wrist score를 측정하여 비교하였으며 방사선학적 평가로 수근 높이 비와 척 수근 거리 비, 요주상 각을 측정하고 요주상 관절의 퇴행성 변화를 관찰하였다. 결과: 수술 후 신전 운동 범위 보존율은 월상골을 제거한 군이 수술 전의 94%로 제거하지 않은 군보다 더 보존되는 양상을 보였다. 방사선학적 평가상 수근 높이 비, 척 수근 거리비와 요주상 각은 두 군 간에 유의한 차이가 없었으나 요주상 관절의 퇴행생 변화가 월상골을 제거한 군에서 더 많은 빈도로 나타났다. 결론: 진행된 Kienbock 질환에서 삼주상 유합술 시 월상골을 제거하는 것은 후방 충돌로 인한 증상을 완화 할 수 있으나, 요주상 관절의 퇴행성 변화가 많이 유발되므로 그 시행에 신중을 요할 것으로 생각된다. Purpose: To evaluate the necessity and effectiveness of a lunate excision in triscaphe fusion for the treatment of advanced Kienbock's disease. Materials and Methods: Twenty-six patients who underwent a triscaphe fusion for Kienbock's disease (IIIb) were analyzed. Fifteen patients received triscaphe fusion only and 11 patients received triscaphe fusion and a lunate excision. The indication for a lunate excision included pain and limited motion due to posterior impingement associated with a severely collapsed lunate. The range of motion and modified Mayo wrist score in the two groups were compared. The carpal height ratio, ulnocarpal distance ratio and radioscaphoid angle were measured on the plain radiographs, and the presence of degenerative change was evaluated. Results: The mean extension range was more preserved in the lunate excision group than in the lunate preserving group. Several radiology indices were similar in the two groups, but a degenerative change in the radioscaphoid joint was observed in 45.5% of the lunate excision group and in 13% of the lunate preserving group. Conclusion: When performing the triscaphe fusion in advanced Kienbock's disease, excision of the lunate can relieve the symptoms of posterior impingement. However, this procedure should be carried out carefully because degenerative changes in the radioscaphoid joint are frequently observed.

손목관절 관절원반의 퇴행변화 및 발달뼈의 안쪽관절면에 관한 연구

이규석,정인혁 관동대학교 의과학연구소 2001 關東醫大學術誌 Vol.5 No.1

This study was performed to observe the degenerative changes of the articular disc of the wrist joint and the medial facet of the lunate. The anteroposterior length of the articular disc was 15.3±2.2mm, the width was 10.6±1.1mm and the thickness was 1.5 ±0.3mm at the central portion, 4.7±0.9mm at the peripheral portion. The degenerative changes were appeared as perforation and the incidence was 68.9%. The perforation classified into the three types. Type I is the tearing perforation and the incidence was 33.3%. Type II is the widespread perforation and the incidence was 31.1%. Type III is round perforation and the incidence was 4.5%. The medial facet of the lunate was a variation of carpal bones. The articular facet was formed between lunate and hamate and the incidence was 62.2%. The width of the facet was 3.5(1.0-5.9)mm in average. The articular facet undergo the degenerative changes as the erode of the articular cartilage. The incidence of these erode occurs 10.7% at lunate, 14.3% at hamate,14.3% at both carpal bones.

월상골의 골절이 동반된 월상골 주위 손상

박현수,김성재,박성배,이광현 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.2

저자들은 월상골의 골절과 주상골의 요부 골절 및 삼각골과 두상골의 수배측 피질골 견인 골절을 동반한, 흔하지 않은 손상에 대한 증례 보고를 소개하고자 한다. 주상골의 분쇄 골절은 진행성 월상골 주위 불안정성의 1단계에 해당하는 수근관절의 과신전에 의해 발생한 것으로 보이며, 월상골의 골절은 기존의 진행성 월상골 주위 불안정성의 기전에는 포함되어 있지 않은 유구골의 월상골을 향한 축성 압박력에 의하여 발생한 것으로 추측한다. 주상골에 대하여 비관혈적 정복 및 나사못 고정술을 시행하였으며, 월상골의 골절 및 동반된 다른 손상들에 대하여 외고정 장치를 시행하였다. 이는 유구골의 월상골에 대한 축성 압박력을 중화시켜 월상골의 추가적인 함몰을 막기 위한 목적으로 시행하였다. 29개월의 추시 결과 방사선학적 및 임상적으로 좋은 결과를 얻을 수 있었다. 저자들은 문헌 고찰과 함께 흔하지 않은 이러한 손상에 대한 치료상의 주의점에 대하여 기술하고자 한다. We present an atypical case of combined comminuted lunate fracture and the scaphoid waist fracture, chip fracture of triquetrum and pisiform. Comminuted scaphoid waist fracture was caused by forced hyperextension of the wrist, similar mechanism to stage I of progressive perilunate instability (PLI), and lunate fracture might be caused by axial compression force, does not appear on the original theory of PLI. We performed closed reduction and screw fixation for the scaphoid fracture and immobilized and mildly distracted the wrist joint with the use of a bridging external fixator to prevent further collapse of comminuted lunate by neutralizing the compression force imposed by the capitate on the lunate. We achieved excellent radiological and clinical outcomes at 29-months of follow-up. We aimed to introduce this rare injury and clinically important points in its treatment with the review of the literature.

간과된 월상골 전방 탈구로 인한 수근관 증후군과 수지 굴곡건 파열

정영율,장영재 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

월상골 전방 탈구는 비교적 드문 손상으로 진단이 지연되는 경우 정중신경 압박으로 인한 수근관 증후군과 마멸로 인한 굴곡건 파열이 발생할 수 있다. 저자들은 진단이 지연된 월상골 전방 탈구로 인하여 수근관 증후군과 제2수지 굴곡건 파열이 동시에 나타난 증례를 경험하였다. 이에 대하여 월상골 절제 및 정중신경 유리술, 장장근건을 이용한 제2수지 굴곡건 재건술을 시행한 후 1년 추시상 좋은 임상적 결과 및 방사선학적 결과를 얻은 바 있어 이에 대하여 보고하고자 한다. Anterior dislocation of lunate is rare, it can result in median nerve compression and attritional rupture of flexor tendon when delay diagnosed. We report a patient with second finger flexor tendon rupture and carpal tunnel syndrome caused by neglected anterior lunate dislocation. Patient underwent operative treatment for that excised lunate, released carpal tunnel and reconstructed second flexor tendon using palmaris longus tendon. One year after surgery, fucntional and neurologic symptom were recovered. Also carpal alignment was maintained on plain radiographs, even after excision of the lunate.

진구성 단독 월상골 골절

이창훈,배찬일,박성배,박현수 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.1

Isolate fracture of lunate is very rare. The authors reported a neglected fractureof lunate which was founded incidentally after the dorsal wall fracture of triquetrum. Pain reduction and improvement of range of motion was achievedafter excising the dorsal fragment of lunate. 단독 월상골 골절은 매우 드물게 발생한다. 저자들은 삼각골 체부의 배측 골절 후 우연히 발견된 진구성 월상골 골절에대해 배측 골편제거술을 시행하여 통증 감소 및 관절 운동 범위 향상을 얻었기에 문헌 고찰과 함께 보고하는 바이다.

제 4+5 신전 구획 동맥 유경 골이식술을 이용한 키엔벡병의 치료 : 초기 경험

천상진(Sang Jin Cheon),임종민(Jong Min Lim),김휘택(Hui Taek Kim),서정탁(Jeung Tak Suh) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.4

목적: 키엔벡 병에 대한 유정 골이식술을 이용한 수술적 치료는 환자의 수근관절의 증상을 완화시키고 월상골의 붕과를 막을 수 있는 것으로 알려져 있다. 이에 제 4+5 신전 구획 동맥 유경 골이식술을 시행한 초기 경험으로서 환자의 수근관절의 기능과 주관적인 만족도를 평가하여 그 유용성을 알아보고자 하였다. 대상 및 농법: 키엔벡 병으로 제 4+5 신전 구획 동맥 유경 골이식술을 시행받은 6명의 환자를 대상으로 하였다. 남자가 3명, 여자가 3명이었으며, 평균 나이는 37.5세(21-49세)였다. 병기는 Lichtman 분류를 이용하였으며, Lichtman 병기 Ⅱ가 3명, ⅢA가 3명이었다. Cooney 평가법을 이용하여 통증의 경중, 기능의 정도, 운동 범위 및 파악력의 변화에 대하여 평가하였으며, 환자의 주관적 만족도와 단순 방사선 사진상 capal height ratio의 변화 및 골유합 여부, 합병증 발생 유무에 대하여 조사하였다. 추시 기간은 평균 2년 6개월이었다. 결과: Cooney 평가법상 4예에서 우수, 2예에서 양호의 결과를 보였다. 환자의 주관적 만족도는 우수가 3예, 양호가 3예를 보였다. 방사선 소견상 유경 골이식술을 시행받은 환자에서 만족할 만한 골유합 소견을 보였고 더 이상의 골 괴사소견은 보이지 않았다. Carpal height ratio의 측정 상 수술 전후의 변화는 거의 없어 수근골의 붕괴소견은 관찰되지 않았다. Lichtman 병기 ⅢA인 2예에서 수술 전 보였던 월상-유두관절의 경한 관절염 소견은 변화가 없음을 관찰할 수 있었고, 피부괴사나 감염 등의 합병증은 관찰되지 않았다. 결론: 키엔벡 환자에서 제 4+5 신전 구획 동맥 유경 골이식술을 이용한 수술적 치료는 Lichtman 병기 Ⅱ와 ⅢA인 환자에서 통증 경감과 운동범위를 향상시킬 수 있고 방사선 소견상 수근골간 관계를 유지할 수 있으며 합병증의 발생이 드물어 유용한 방법 중 하나로 사료된다. Purpose: Kienbock's disease can be treated with a vascularized bone graft to provide relief of wrist joint symptoms and prevent collapse of the lunate. We evaluated the functional outcome and subjective satisfaction in patients with Kienbock's disease treated with the 4+5 extensor compartmental vascularized bone graft. Materials and Methods: We included 6 patients in the study. 3 males and 3 females with an average age of 37.5 years (range 21-49). Kienbock's disease was staged by Lichtman classification based on plain radiography. Three patients were in stage Ⅱ and three in stage ⅢA. Cooney's wrist function score was used to evaluate changes in severity of pain. functional status, range of motion, and grip strength We also assessed subjective patient satisfaction, carpal height ratio and bone union on the radiographs, and the occurence of complications. The mean follow-up period was 30 months. Results: Four patients had excellent and two had good outcomes of wrist function. Three patients showed excellent subjective satisfaction, and three were good. All patients showed radiographic bone union and no further progression of lunate necrosis. The presurgical carpal height ratio was similar to the value at last follow-up, and there was no radiographic carpal bone collapse. For two cases of Lichtman stage ⅢA, the slight degenerative arthritis at the lunocapitate joint observed preoperatively did not change. Skin necrosis and pin track infection were not observed. Conclusion: The 4+5 extensor compartmental vascularized bone graft is a reliable procedure for Lichtman stage Ⅱ and ⅢA patients with Kienbock's disease, as it achieved not only pain relief and improvement of range of motion but also maintenance of the intercarpal bone relationship on radiographs, with relatively few complications

The Role of Lunate Morphology on Scapholunate Instability and Fracture Location in Patients Treated for Scaphoid Nonunion

Byoung-Jin Kim,David Kovacevic,Young-Min Lee,Young-Min Lee,Jong-Hwan Seol,김명선 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.2

Background: To determine the association between lunate morphology and the scapholunate instability using radiographic images, and investigate the association between lunate morphology and scaphoid fracture location. Methods: Between January 2003 and December 2011, we retrospectively evaluated the plain radiographs and computed tomography (CT) images of 70 patients who underwent surgical intervention for a scaphoid nonunion, in order to determine the association between lunate type (I or II) and scapholunate instability or scaphoid fracture location. We determined the scaphoid fracture location using the fragment ratio and measured the radiolunate angle and capitate-triquetrum (C-T) distance. Results: A type II lunate was present in 68.6% (48 of 70 cases). Mean fragment ratio of fracture location was 50.6% in the type II lunate group and 56.2% in the type I lunate group (p = 0.032). Sixteen of the 70 patients had dorsal intercalated segmental instability (DISI) deformities. Nine of 22 cases showed DISI deformity in type I lunate and 7 of 48 cases showed DISI deformity in type II lunate (p = 0.029). However, there were no significant differences between the presence of DISI deformity and fracture location (p = 0.15). Morphologic comparisons by both plain radiography and CT indicated a mean C-T distance in the type I lunate group (22 cases) of 2.3 mm and 5.0 mm in the type II lunate group (48 cases). The C-T distances were significantly correlated with lunate morphology (p = 0.001). Conclusions: A type II lunate was associated with low incidence of DISI deformity and proximal location of fracture in patients presenting with a scaphoid nonunion.

Ultrasonography Detected Missed Lunate Volar Dislocation Associated With Median Neuropathy: A Case Report

김경원,김민욱 대한재활의학회 2017 Annals of Rehabilitation Medicine Vol.41 No.4

Lunate and perilunate dislocations are uncommon, but they have clinical importance because complications, such as median neuropathy and avascular necrosis of the lunate, can occur. Although early diagnosis enabling early surgical treatment is crucial for preventing long-term sequelae, these dislocations are frequently missed in the initial assessment. Imaging tools, such as plain radiography, magnetic resonance imaging, ultrasonography, and electrodiagnostic studies, have been used for diagnosis. The proper choice of initial evaluation tools is important for making an accurate early diagnosis. Here we present a case of lunate dislocation associated with median neuropathy in which ultrasonography, along with the electrodiagnostic study and plain radiography, played an important diagnostic role in detecting structural abnormalities. This case report reveals the complementary diagnostic role of ultrasonography in initial assessment and provides ultrasonographic images of lunate dislocation as a cause of median neuropathy.

봉합나사 및 금속강선 고정술을 이용한 월상골 주위 탈구에 대한 치료

김갑래,현윤석,신성일,박정섭,한결,홍성엽 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.4

Chronic lunate dislocations are very rare injuries comprising of less than 10% of all wrist injuries. Volar lunate dislocations account for less than 3% of perilunate dislocations. We present a case of a missed volar lunate dislocation for 6months after initial injury. He fell down and had hyperextension injury during his sports activity. When the patient visit in our hospital, neurologic symptom was devel- oped in distribution of median nerve. Tingling sensation and radiation symp- tom was found in affected hand. A plain radiograph revealed a volar lunate dis- location. Nerve conduction studies confirmed compression of the median nerve at the wrist, carpal tunnel level. Operation was performed with open reduction of lunate, fixation with K-wires and anchor suture. The outcome was excellent in relieving pain, function, range of motion, grip strength. There was improve- ment in Mayo wrist score and disabilities of the arm, shoulder and hand score. So we report a patient and a operation technique which can be considered in similar cases. 만성적 월상골 탈구는 매우 드문 손상이며 모든 완관절 손상의 10% 미만을 차지한다. 그 중 배측 월상골 탈구는 월상골탈구 중 3% 미만에서 발생한다. 환자는 과신전 상태로 넘어지며 수상하였으며 초기 손상 이후 6개월이 지난 상태였다. 내원시 제2-4 수지의 저리는 증상과 이상감각증이 동반되어 있었으며, 방사선 사진상 배측 월상골 탈구를 확인하였다. 이에 본 저자는 관혈적으로 탈구를 정복하고, 주상골-월상골-삼각골간의 근위부위를 봉합나사 및 금속강선을 이용하여 고정하였다. 수술 후 완관절의 통증완화, 운동범위 회복, 수술전의 기능회복 및 Mayo wrist score와 disabilities of the arm, shoulder and hand score상에서 좋은 결과를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.