Preiser's Disease; Surgical Functional Outcome and Radiological Assessment

Purpose: To determine the functional outcome and evaluate different surgical treatments in management of Preiser’s disease in our institution.  

Materials and Methods: A retrospective review of all patients undergoing surgical intervention for Preiser’s disease between 1987 and 2015 was performed. All patients had proper diagnostic imaging confirming the diagnosis. Postoperative outcomes were measured and compared between different modalities according to the disease stages. Twenty-four patients were included in the study with confirmed diagnosis and minimum follow up of 12 months (mean 24.6 months).    

Results : Out of 24 included patients, 3 (12.5%) were stage II, 16 (67.7%) stage III, and five (20.8%) stage IV.  Fifteen patients were initially treated nonoperatively, with minimal symptomatic improvement, all requiring eventual operative intervention. Surgical techniques included vascularized bone grafting from the distal radius, pisiform, or hamate, proximal row carpectomy, four-corner fusion, vascular bundle transplantation, or silastic arthroplasty. Pain improved following surgery but remained present to some degree in 17 patients. Patients undergoing VBG (65%) had a decrease in their preoperative wrist flexion-extension arc from 99.9°, flexion of 50.9° and extension of 49.0° to arc of 67.1°, flexion of 26.4° and extension of 40.7°. The radio-ulnar deviation arc decreased from 48.0° to 41.1°.

Conclusions: The infrequent incidence of Preiser’s disease did not allow us to investigate the effect of different surgical modalities on stages of Preiser’s disease. The active wrist motion decreased especially the flexion-extension arc and the isolated flexion after vascularized bone graft. The grip strength slightly improved. Further multicenter studies are recommended.