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The Clinical Outcomes of Surgical Treatment for Preiser disease
Narihito Kodama, MD, PhD
Shiga University of Medical Science, Otsu, Shiga, Japan
(Objective) Preiser's disease, of which pathogenesis is unknown, is a rare condition. The surgical procedures have not been established. Vascularized bone grafting is one of the most commonly performed procedure in the past reports. In this study, we describe the results and outcomes of the surgical treatment with vascularized bone grafting for this disease.
(Methods) Nine patients who underwent vascularized bone grafting (VBG) for Preiser's disease between 2006 and 2022, and were able to be followed up for at least one year. One patient was male and eight were female, including eight right hand and one left hand. The mean age was 60.1 years. 1 case was Stage 1, 4 cases were Stage 2, and 4 cases were Stage 3 according to the Herbert classification. 8 patients underwent VBG with 1, 2 Intercompartmental Supraretinacular Artery (1, 2 ICSRA) reported by Zaidemberg. 1 patient with medial femoral trochlea osteochondral Flap. The evaluation was performed by Mayo wrist score, radiographic images, and range of motion of the wrist joint.
(Results) The preoperative Mayo Wrist Score was poor in all cases and in the latest follow-up, all patients had improved to fair (2 cases) and good (7 cases) postoperatively. In the latest radiographic findings, there was no worsening of stage at in the preoperative stage 1 patients. One of the four preoperative stage 2 patients had progressed to stage 3. Three of the four preoperative stage 3 patients had progressed to stage 4. Although there were a few cases of postoperative limitation of palmar flexion, the range of motion of the wrist joint was generally improved from the preoperative level.
(Discussion) Although vascularized bone grafting for Preiser's disease may cause progression of the disease in the radiographic findings, it is effective procedure in improving the symptoms. In particular, the possibility of postoperative progression of stage 3 is high, and the indication for this procedure should be carefully considered.
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