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

BACKGROUND: The optimal surgical approach for Preiser disease, a rare avascular necrosis of the scaphoid, remains unclear. Our institution employs a stage-based strategy: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early disease (Herbert classification stages 1-2) and proximal row carpectomy (PRC) for advanced disease (stages 3-4). This study evaluates this stage-based surgical approach. METHODS: We retrospectively analyzed 8 patients (mean age: 60.6 years) who underwent surgical treatment for Preiser disease between 2000 and 2019. Preoperative evaluation included Herbert and Kalainov classifications. Outcome measures included the range of motion (ROM), grip strength (GS), pain (numeric rating scale [NRS] score), Modified Mayo Wrist Score (MMWS), and radiological parameters. Mean follow-up was 50 months. RESULTS: Five patients had stage 2, 1 had stage 3, and 2 had stage 4 disease. Seven patients were treated according to our strategy; 1 stage 4 patient deviated. In those treated per protocol, the VBG/CRWO group (n = 5) and the PRC group (n = 2) showed improvements across all clinical outcomes. Despite clinical gains, radiographic disease progression occurred in 4 of the 5 patients in the VBG/CRWO group. The patient treated outside the standard approach experienced clinical deterioration and developed dorsal intercalated segment instability deformity. CONCLUSION: Our stage-based surgical strategy for Preiser disease yields favorable clinical outcomes. While radiographic progression may occur regardless of treatment, clinical improvements are generally maintained when procedures are appropriately selected based on disease stage.