Abstract
Introduction: Osteonecrosis is a devastating disease which can affect multiple joints including the distal radius. Although there are a number of studies that have reported the clinical outcomes of patients treated for osteonecrosis of the hip, knee, shoulder, and other locations, there are no known studies that have evaluated the outcome of patients who have this disease in the distal radius. The purpose of this study was to assess the characteristics of atraumatic, symptomatic osteonecrosis of the distal radius. In addition, based on reports that have shown the safe and effective use of core decompressions to treat early stages of osteonecrosis in other joints, we assessed whether this treatment modality also would provide pain relief and delay progression of the disease in the distal radius.
Methods: A review of 434 osteonecrosis patient records from the past 7 years in our prospectively collected database identified 4 patients (6 wrists) who had the disease in the distal radius. Two of these patients also had the disease in the ulna. All 4 patients were women, and their mean age was 46 years (range, 37 to 52 years). Clinical and radiographic outcomes were assessed at a mean of 39 months (range, 12 to 84) following treatment with core decompression. The clinical evaluations were conducted using the Michigan Hand Outcomes Questionnaire (MHQ). The reported pre-operative MHQ component scores for function, completion of everyday activities, pain, completion of work activities, overall appearance of the hands, and patient satisfaction were compared to the results of the MHQ at final follow-up. Radiographic success of the core decompressions was based on whether there was any progression in the stage of the disease.
Results: The most common risk factor for this cohort of patients was corticosteroids with 3 of the 4 patients having reported prior use. Other risk factors included alcohol consumption on a regular basis (n = 2), tobacco abuse (n = 2), blood dyscrasia (n = 2), and systemic lupus erythematosus (n = 1). Additionally, all 4 patients had multifocal osteonecrosis (affecting at least four separate anatomic sites. Overall, the patients reported a mean improvement in MHQ score (from 65% to 84%). Stratified by category, satisfaction improved from 64% to 88%, overall hand function increased from 64% to 81%, and pain was reduced from 60% to 25%, for pre- and post-operative values, respectively. One patient (2 wrists) required additional core decompressions in each wrist at one year following surgery but reported sustained improvement in her MHQ for both wrists at two years following her second core decompressions. There were no complications associated with the core decompressions, and there was no radiographic progression in the stage of the disease in any of the cases.
Discussion: Osteonecrosis of the distal radius is rarely found in patients with this disease (< 1%). It can be found in patients with osteonecrosis of other joints who have a symptomatic wrist and may have more than one risk factor. It can be readily diagnosed with x-rays and/or MRI. The results of the present study suggest that core decompression is a safe and effective treatment modality for symptomatic osteonecrosis of the wrist at the distal radius and/or ulna. Although the level of improvement in MHQ varied for each case, all patients reported reduced pain and improved function at final follow-up without any apparent complications. Based on these results, we recommend the use of core decompressions to alleviate the symptoms and to possibly delay the progression of distal radius osteonecrosis.
The abstracts were prepared by Lynne C. Jones, PhD. and Michael A. Mont, MD. Correspondence should be addressed to Lynne C. Jones, PhD., at Suite 201 Good Samaritan Hospital POB, Loch Raven Blvd., Baltimore, MD 21239 USA. Email: ljones3@jhmi.edu
