TY - JOUR
T1 - Avascular Necrosis of the Scaphoid-Preiser Disease
T2 - Outcomes of 39 Surgical Cases
AU - Amundsen, Asgeir
AU - Oh, Christine
AU - Huang, Tony C.T.
AU - Cantwell, Sean
AU - Hsu, Chung Chen
AU - Moran, Steven L.
N1 - Publisher Copyright:
© 2021 American Society for Surgery of the Hand
PY - 2021
Y1 - 2021
N2 - Purpose: There is no established treatment standard for patients with idiopathic avascular necrosis of the scaphoid, also known as Preiser Disease. We evaluated outcomes of operative interventions performed for patients diagnosed with Preiser Disease and assessed scaphoid morphology in the contralateral wrists. Methods: We performed a retrospective review of all patients undergoing surgery for Preiser disease between 1987 and 2019 at our institution. A total of 39 wrists in 38 patients were identified. The mean age was 37 years at the time of surgery, and the median follow-up time was 5.3 years. The patients were classified according to the Herbert and Kalainov classifications. Pre- and postoperative pain and functional outcomes were evaluated, and Mayo Wrist Scores were calculated. Reoperations for complications were recorded. Scaphoid shapes were assessed for wide/type 1 and slender/type 2 scaphoids in the contralateral unaffected wrist in patients with unilateral disease. Results: Overall, pain and Mayo Wrist Scores improved, while flexion/extension decreased slightly and grip strength remained stable. In a comparison of the 2 main surgery groups, 17 wrists with a pedicled vascular bone graft and 12 wrists with salvage surgery (4-corner fusion/proximal row carpectomy) showed similar functional outcomes. Similar outcome scores were found regardless of preoperative Herbert or Kalainov classifications. Radiographic morphologic evaluation of the contralateral side determined that 4 of 8 patients had a slender scaphoid shape, which has been shown to have a more limited vascular network when compared to full scaphoids. Conclusions: A treatment algorithm of Preiser disease is lacking and the optimal surgical treatment remains controversial. Pedicled vascular bone grafts had similar functional outcomes as salvage procedures, but preserving the scaphoid was possible in 70% of the pedicled vascular bone graft cases. A slender scaphoid is potentially more common in patients with Preiser disease who undergo surgery. Type of study/level of evidence: Therapeutic IV.
AB - Purpose: There is no established treatment standard for patients with idiopathic avascular necrosis of the scaphoid, also known as Preiser Disease. We evaluated outcomes of operative interventions performed for patients diagnosed with Preiser Disease and assessed scaphoid morphology in the contralateral wrists. Methods: We performed a retrospective review of all patients undergoing surgery for Preiser disease between 1987 and 2019 at our institution. A total of 39 wrists in 38 patients were identified. The mean age was 37 years at the time of surgery, and the median follow-up time was 5.3 years. The patients were classified according to the Herbert and Kalainov classifications. Pre- and postoperative pain and functional outcomes were evaluated, and Mayo Wrist Scores were calculated. Reoperations for complications were recorded. Scaphoid shapes were assessed for wide/type 1 and slender/type 2 scaphoids in the contralateral unaffected wrist in patients with unilateral disease. Results: Overall, pain and Mayo Wrist Scores improved, while flexion/extension decreased slightly and grip strength remained stable. In a comparison of the 2 main surgery groups, 17 wrists with a pedicled vascular bone graft and 12 wrists with salvage surgery (4-corner fusion/proximal row carpectomy) showed similar functional outcomes. Similar outcome scores were found regardless of preoperative Herbert or Kalainov classifications. Radiographic morphologic evaluation of the contralateral side determined that 4 of 8 patients had a slender scaphoid shape, which has been shown to have a more limited vascular network when compared to full scaphoids. Conclusions: A treatment algorithm of Preiser disease is lacking and the optimal surgical treatment remains controversial. Pedicled vascular bone grafts had similar functional outcomes as salvage procedures, but preserving the scaphoid was possible in 70% of the pedicled vascular bone graft cases. A slender scaphoid is potentially more common in patients with Preiser disease who undergo surgery. Type of study/level of evidence: Therapeutic IV.
KW - Avascular necrosis scaphoid
KW - Preiser disease
KW - scaphoid vascularity
KW - vascularized bone graft
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U2 - 10.1016/j.jhsa.2021.10.023
DO - 10.1016/j.jhsa.2021.10.023
M3 - Article
AN - SCOPUS:85120684397
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0266-7681
ER -