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.
Key words
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Article info
Publication history
Published online: December 06, 2021
Accepted:
October 13,
2021
Received:
January 3,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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