‘Osteonecrosis of the lunate’- Kienbock’s Disease
As a living Tissue the bone essentially requires:
continuous blood supply to enable functionality. Interruption in the blood supply can make the bone die being referred to as Osteonecrosis. Blood supply can be hindered because of a severe traumatic injury, fracture or dislocation or even without any concrete cause. But if not treated, osteonecrosis can cause the joint to deteriorate and result in severe arthritis.
The wrist is made of a framework:
of eight carpal bones. These carpal bones provide mobility and flexibility to the wrist of a human hand. One among the eight carpal bones is ‘The Lunate’. When blood supply to the lunate gets interrupted it causes clinical death of the bone or avascular necrosis leading to the disease which is known as Kienbock’s disease, a rare and debilitating medical condition resulting in chronic impairment.
Cause of Kienbock’s being unfathomable:
may seem to be just a sprain initially. When pain, numbness, swelling, limited motion ability with decrease in grip strength is visible, then it is relatively diagnosed by various imaging tests and concluded that the patient might be suffering from Kienbock’s disease. The hand specialist Dr. Gupta formulates a treatment plan accordingly to restore the lunate by both surgical or non surgical techniques.
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Rationale:
When lunate, one of the smaller carpal bones that make up the wrist receives an interrupted supply of blood and clinically becomes inactive i.e. completely damaged to perform any function, the condition is referred to as osteonecrosis of the lunate or Kienbock’s disease. Kienbock’s disease marks its presence by persistent and intense pain, swelling, tenderness right over where the lunate bone is located, difficulty in making an upward movement with the hand and loss in grip strength.
The patient should consult our medical team >>click here for appointment
Approach Considerations:
It takes a long time to understand that the condition that appears to be wrist sprain may be kienbock’s disease. Passing through four stages of progress the wrist surgeon has to diagnostically identify at which stage the disease is and which technique would be most applicable to the damaged lunate. Revascularization is taken up when the lunate is still partially functional (stage 1 and 2) and can become normal if blood supply is adequately provided to it.
Preoperative Evaluation and Preparation:
The wrist surgeon evaluates the condition of the wrist and with the help of imaging tests inclusive of X-ray, MRI, CT scan, ascertains the severity and the stage of the disease. After determining that the lunate is in stage 1 or 2 and can be salvaged the surgeon informs and discusses all pros and cons of the condition and the technique with the patient. Thereafter the patient is asked to get a clear signal from his general physician that he can go ahead with the surgery by having run some general health tests on himself.
After all formalities regarding each and every detail that the wrist surgeon thinks essential are completed, the surgery is proceeded with.
The Technique:
Before the lunate becomes completely damaged, the wrist surgeon taps on the possibility of making it functional again by facilitating regular blood supply to it by the procedure referred to as revascularization. The procedure involves removing portion of a bone along with blood vessels from another bone and inserting it into the lunate bone. The part of bone that is taken out is usually from the radius bone in the forearm or in the hand. It is known as a vascularized graft. To help the bones to heal and relieve pressure on lunate, the wrist surgeon fixes them with metal device and inserts it into the wrist with pins.
Postoperative Follow up:
After the successful completion of the surgery the wrist is covered in a protective bandage and placed in a splint for almost 12 weeks or so. The patient is kept under close monitoring until the surgeon feels convinced that he can be released from the hospital. To monitor the progress of the bone, the wrist surgeon schedules regular follow up visits and removes the splint after being clinically convinced that the bones have become stable and healed.
Postoperative Complications:
Surgical techniques are usually prone to some complications which may vary from case to case. The technique may fail to provide adequate supply of blood to the lunate. It may be prone to some infection due to metal implants or may sustain an associated nerve injury while taking out the bone graft and inserting it.
Postoperative Benefits:
As with any other surgery the patient experiences restored strength and improvement in the mobility functions. The pain decreases tremendously though stiffness may still be prevalent in a few cases. The lunate heals and starts to function on its own as the vascularized graft along with blood vessels help induce blood in the lunate.
Postoperative Rehabilitation:
A well formulated personalized rehabilitation program is a prerequisite for complete recovery from the surgery. The program is a strict exercisable regime to be followed for eight to twelve weeks in which the patient learns strengthening and stabilizing exercises under the guidance of a skilled therapist, both passively and actively. The patient is also taught how to adapt to activities and surroundings without exerting pressure on the wrist.
The patient should consult our medical team >>click here for appointment
More about wrist surgeon:
He is an ingenious professional who passionately believes in deliverance of techniques to relief his patients of each and any debilitation in the hand. Dr. Vikas Gupta with his compassionate approach and accurate diagnosis is easily one of the most experienced and skillful wrist doctors in the country. His presence at various national and international seminars, his introduction of various international techniques to Indian field of deliverance has received acclamation and he is an influential role model for his peers and interns.
His experience in the field is more than 25 years with more than 6000 surgeries and innumerable cases that have been provided relief by his nonsurgical prescription and combination of techniques. An MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and Fellowship from Germany and USA, he has delivered treatment to patients all around the country from various hospitals that include AIIMS as associate professor, Consultant Hand & Upper Extremity Surgery (orthopedics) At Fortis Hospitals, Director, Hand & Upper Extremity Surgery (orthopedics) At Medanta – The Medicity, Gurgaon and at present head of Hand and Shoulder division at Max Healthcare, the super specialty hospital in Delhi- NCR region.