Stage-Based Surgical Strategies and Outcomes for Preiser Disease: A Single-Center Experience

Area of Science:

• Orthopedic surgery
• Hand surgery
• Avascular necrosis

Background:

• Preiser disease, a rare avascular necrosis of the scaphoid, lacks a defined optimal surgical strategy.
• A stage-based approach is utilized: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early stages (Herbert 1-2), and proximal row carpectomy (PRC) for advanced stages (3-4).

Purpose of the Study:

• To evaluate the efficacy of a stage-based surgical strategy for treating Preiser disease.
• To assess clinical and radiological outcomes of different surgical interventions based on disease severity.

Main Methods:

• Retrospective analysis of 8 patients with Preiser disease (2000-2019).
• Preoperative classification using Herbert and Kalainov systems.
• Outcome assessment included range of motion, grip strength, pain (NRS), Modified Mayo Wrist Score, and radiographic parameters.
• Mean follow-up duration was 50 months.

Main Results:

• Five patients had stage 2, one stage 3, and two stage 4 disease.
• Seven patients were treated according to the protocol; one stage 4 patient deviated.
• VBG/CRWO (n=5) and PRC (n=2) groups showed clinical improvements.
• Radiographic progression occurred in 4/5 patients in the VBG/CRWO group.
• The patient treated off-protocol experienced clinical deterioration and deformity.

Conclusions:

• A stage-based surgical strategy for Preiser disease leads to favorable clinical outcomes.
• Clinical improvements are generally sustained with appropriate procedure selection, despite potential radiographic progression.