RESUMEN
Purpose: Preiser disease is difficult to diagnose and treat because of its unclear pathophysiology. Although both nonsurgical treatment and surgical treatment for Preiser disease have been reported, there is no consensus on the optimal treatment because of its rarity. The purpose of this study was to investigate the relationship between treatment selection and characteristics of patients with Preiser disease. Methods: This single-institution retrospective chart review included nine patients (two men and seven women) with Preiser disease who were treated at our hospital. We divided patients into two groups consisting of elderly (older than 65 years of age) and nonelderly patients. Herbert-Lanzetta classification, presence of dorsal intercalated segment instability (DISI), Watson classification based on plain radiography, Kalainov classification based on magnetic resonance imaging, and treatment modalities were investigated in both groups. Results: In the elderly group, three of five cases were in advanced stages of Preiser disease according to the Herbert-Lanzetta classification. Three wrists had a DISI deformity. Three patients underwent conservative treatment. The two remaining cases classified as Herbert-Lanzetta stage II underwent closing radial wedge osteotomy. In the nonelderly group, three of four cases were in the early stages of Preiser disease according to the Herbert-Lanzetta classification. One wrist had a DISI deformity. Two patients were treated conservatively. The other two patients were surgically treated using closing radial wedge osteotomy in one case and vascularized bone graft from the second metacarpal base in another case, both classified as Herbert-Lanzetta stage II. Conclusions: Most elderly patients with Preiser disease showed concurrent DISI at the time of initial presentation and advanced stage. Most elderly patients underwent nonsurgical treatment. Even when surgical treatment is implemented, our study suggests that the less invasive and optimal treatment is closing radial wedge osteotomy. Type of study/level of evidence: Therapeutic IV.
RESUMEN
PURPOSE: To determine clinical outcomes of Preiser disease treated with closing radial wedge osteotomy (CRWO). METHODS: Seven patients with Preiser disease underwent CRWO. Two wrists had stage 2 disease, 3 had stage 3, 2 had stage 4 (Herbert-Lanzetta classification). Magnetic resonance imaging (MRI) showed that 4 wrists had stage 1 and 3 had stage 2 indicating complete and incomplete necrosis, respectively (Kalainov criteria), before surgery. Two wrists had concomitant Kienböck disease. The range of motion (ROM) of the wrists was restricted owing to pain, and median Modified Mayo Wrist Score (MMWS) was 15 points. Patients were followed after surgery with radiography, MRI, and clinical evaluation (ROM, grip strength, MMWS). Radiolunate and scapholunate angles were calculated on lateral radiographs. RESULTS: Although there were no usual postoperative complications (eg, infection, neuropathy, distal radius nonunion), 1 patient had an extensor pollicis longus tendon rupture, and another experienced osteoarthritis with deterioration of the distal radioulnar joint. Final follow-up radiography showed that 2 wrists were stage 3, 5 were stage 5 (Herbert-Lanzetta classification). At 1 year after surgery, T1-weighted MRI showed that 2 of 6 wrists had improved from stage 1 to stage 2 (Kalainov criteria). At the final evaluation, 5 wrists had no pain, and 2 had only mild pain. Compared with the contralateral wrist, the median ROM was 80% in extension, 73% in flexion. Median grip strength was 71%, median MMWS was 75 points, and clinical results were good in 1 patient, fair in 5, and poor in 1. CONCLUSIONS: Although follow-up radiography showed that the disease stage had progressed in 4 of 7 patients, wrist pain alleviation, retention of ROM, and improvement of grip strength were obtained. The CRWO may be an option for reducing wrist pain and retaining ROM of the wrist owing to Preiser disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.