Clinical analysis of distal radius core decompression for chronic wrist pain_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Jixin ^1,2,3 , SUN Jiayu ^1,2,3 ^△ , LIU Xin ^1,2,3 , SONG Jie ^1,2,3 , HU Shaonan ^1,2,3 ,  CHEN Liang ^1,2,3

1. Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China;
2. Key Laboratory of Hand Function Reconstruction, National Health Commission, Shanghai, 200032, P. R. China;
3. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200032, P. R. China;

Corresponding author：

CHEN Liang, Email: liangchen1960@163.com

Keywords：

Chronic wrist pain; distal radial core decompression; intramedullary pressure; bone marrow edema

DOI：

10.7507/1002-1892.202303131

Video：

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Objective To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies. Methods A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI. Results All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences (P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up (P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up. Conclusion For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Citation： WU Jixin, SUN Jiayu, LIU Xin, SONG Jie, HU Shaonan, CHEN Liang. Clinical analysis of distal radius core decompression for chronic wrist pain. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 815-820. doi: 10.7507/1002-1892.202303131 Copy

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2.	Scott W, Robert N, Scott H, et al. Green’s operative hand surgery. Philadelphia: Elsevier, 2017: 373-374.
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13.	Ficat RP. Treatment of avascular necrosis of the femoral head. Hip, 1983: 279-295. PMID: 6671916.
14.	Kristensen KD, Pedersen NW, Kiaer T, et al. Core decompression in femoral head osteonecrosis. 18 Stage I hips followed up for 1-5 years. Acta Orthop Scand, 1991, 62(2): 113-114.
15.	王旭, 王亚康, 郭建斌, 等. 髓芯减压术及其辅助疗法在股骨头坏死治疗中作用的研究进展. 中华实用诊断与治疗杂志, 2018, 32(11): 1138-1140.
16.	Franceschi F, Franceschetti E, Paciotti M, et al. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3270-3278.
17.	范存义, 顾玉东. 创伤性肘关节僵硬的国内研究进展. 中华手外科杂志, 2020, 36(1): 1-2.
18.	Jupiter JB, Nunez Jr FA, Nunez Sr F, et al. Current perspectives on complex wrist fracture-dislocations. Instr Course Lect, 2018, 67: 155-174.
19.	Rellan I, Gallucci GL, Boretto JG, et al. Metaphyseal core decompression and anterograde fixation for scaphoid proximal pole fracture nonunion without avascular necrosis. J Wrist Surg, 2019, 8(5): 416-422.
20.	De Carli P, Zaidenberg EE, Alfie V, et al. Radius core decompression for Kienböck disease stage ⅢA: Outcomes at 13 years follow-up. J Hand Surg (Am), 2017, 42(9): 752.e1-752.e6.
21.	张必欢, 蔡兴博, 王斌, 等. 舟大小关节炎病因与临床诊疗研究进展. 中国修复重建外科杂志, 2023, 37(1): 101-105.

1. Palmer KT. Regional musculoskeletal conditions: pain in the forearm, wrist and hand. Best Pract Res Clin Rheumatol, 2003, 17(1): 113-135.
2. Scott W, Robert N, Scott H, et al. Green’s operative hand surgery. Philadelphia: Elsevier, 2017: 373-374.
3. Larsen RM. Intramedullary pressure with particular reference to massive diaphyseal bone necrosis: Experimental observations. Ann Surg, 1938, 108(1): 127-140.
4. Illarramendi AA, De Carli P. Radius decompression for treatment of kienböck disease. Tech Hand Up Extrem Surg, 2003, 7(3): 110-113.
5. Caloia MF, Caloia HF, Scotti DG, et al. Arthroscopic treatment of scaphoid nonunion without bone graft and distal radius core decompression: a new approach to an old problem-preliminary report. Hand, 2016, 11(1): 111S-112S.Caloia MF, Caloia HF, Scotti DG, et al. Arthroscopic treatment of scaphoid nonunion without bone graft and distal radius core decompression: a new approach to an old problem-preliminary report. Hand, 2016, 11(1): 111S-112S.
6. Laroche M. Intraosseous circulation from physiology to disease. Joint Bone Spine, 2002, 69(3): 262-269.
7. Beverly M, Mellon S, Kennedy JA, et al. Intraosseous pressure during loading and with vascular occlusion in an animal model. Bone Joint Res, 2018, 7(8): 511-516.
8. Brazill JM, Beeve AT, Craft CS, et al. Nerves in bone: Evolving concepts in pain and anabolism. J Bone Miner Res, 2019, 34(8): 1393-1406.
9. Li C, Peng Z, Zhou Y, et al. The progress in the classification and treatment of scaphoid nonunion. Surgeon, 2022, 20(5): e231-e235.
10. Tanaka T, Ogino S, Yoshioka H. Ligamentous injuries of the wrist. Semin Musculoskelet Radiol, 2008, 12(4): 359-377.
11. Camus EJ, Van Overstraeten L. Kienböck’s disease in 2021. Orthop Traumatol Surg Res, 2022, 108(1S): 103161. doi: 10.1016/j.otsr.2021.103161.
12. 宫旭, 路来金, 王克利. 晚期月骨无菌性坏死舟骨环形征的解剖学及生物力学研究. 中国修复重建外科杂志, 2004, 18(5): 356-359.
13. Ficat RP. Treatment of avascular necrosis of the femoral head. Hip, 1983: 279-295. PMID: 6671916.
14. Kristensen KD, Pedersen NW, Kiaer T, et al. Core decompression in femoral head osteonecrosis. 18 Stage I hips followed up for 1-5 years. Acta Orthop Scand, 1991, 62(2): 113-114.
15. 王旭, 王亚康, 郭建斌, 等. 髓芯减压术及其辅助疗法在股骨头坏死治疗中作用的研究进展. 中华实用诊断与治疗杂志, 2018, 32(11): 1138-1140.
16. Franceschi F, Franceschetti E, Paciotti M, et al. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3270-3278.
17. 范存义, 顾玉东. 创伤性肘关节僵硬的国内研究进展. 中华手外科杂志, 2020, 36(1): 1-2.
18. Jupiter JB, Nunez Jr FA, Nunez Sr F, et al. Current perspectives on complex wrist fracture-dislocations. Instr Course Lect, 2018, 67: 155-174.
19. Rellan I, Gallucci GL, Boretto JG, et al. Metaphyseal core decompression and anterograde fixation for scaphoid proximal pole fracture nonunion without avascular necrosis. J Wrist Surg, 2019, 8(5): 416-422.
20. De Carli P, Zaidenberg EE, Alfie V, et al. Radius core decompression for Kienböck disease stage ⅢA: Outcomes at 13 years follow-up. J Hand Surg (Am), 2017, 42(9): 752.e1-752.e6.
21. 张必欢, 蔡兴博, 王斌, 等. 舟大小关节炎病因与临床诊疗研究进展. 中国修复重建外科杂志, 2023, 37(1): 101-105.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical analysis of distal radius core decompression for chronic wrist pain

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