Biomechanical effect of isolated capitate shortening in Kienböck’s disease: an anatomical study

Abstract

Multiple operations have been proposed to slow the progression of osteonecrosis and secondary carpal damage in Kienböck's disease. To assess the biomechanical changes after capitate shorting, we inserted pressure-testing devices into the carpal and radiocarpal joints in an anatomical study. Pressure sensors were placed into eight thawed non-fixated human cadaver arms to measure the forces transmitted in physiological loading. Longitudinal 9.8 N and 19.6 N forces were applied before and after capitate shortening. After capitate shortening, significant load reduction on the lunate was evident in all specimens. An average decrease of 49% was seen under a 9.8 N load and 56% under a 19.6 N load. The load was transferred to the radial and ulnar intercarpal joints. More relief of pressure on the lunate after isolated capitate shortening is achieved with a shallow angle between the scaphoid and capitate in the posteroanterior radiograph.

Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease

“…The publication by Werber et al 26 has clearly demonstrated that the capitate shortening is very effective in reducing the radiolunate load. Shortening of 2mm, however, can result in a capitate that is not in contact with the lunate.…”

“…Werber et al 26 described that a capitate shortening of 1.8 to 2 mm decreased the radiolunate pressure by 49to 56% and that the load was redistributed to the radial and ulnar columns. 27,28 Viola et al 29 reported a 25% decrease after 2.9-mm capitate shortening.…”

L’ostéotomie du capitatum dans la maladie de Kienböck. Résultats cliniques et radiologiques au recul moyen de 8ans

“…L'ostéotomie du capitatum, selon Horii et al [4], permettrait une décompression de 66 % du lunatum, mais au prix d'un accroissement des pressions de la colonne radio-scapho-trapézienne (150 %). Weber et al [22] retrouvent une diminution de 56 % au prix d'une augmentation des pressions majoritairement au dépend de l'interligne scaphocapitate. L'OAR avec horizontalisation proposée par Nakamura, dont les résultats à long terme sont décrits par Watanabe [18], fait décroître la pression de la fosse lunarienne de 23 %.…”

Osteotomía de acortamiento del hueso grande en la enfermedad de Kienböck asociada a varianza ulnar positiva o neutra

“…Weber et al 35 . La OAR con horizontalización propuesta por Nakamura y comunicados sus resultados a largo plazo por Watanabe et al 36 disminuye un 23% la presión en la fosa semilunar.…”

“…Se confirmó mediante imágenes de RM, en las que aparecía una disminución marcada de la intensidad de la señal con las secuencias T1(fig. 2).En la revisión final de la serie de casos, efectuada entre enero y marzo del 2015, se realizó una evaluación funcional de la muñeca según la escala de Cooney (MAYO modificada)35 . En esta se asocia un control de la movilidad de la muñeca operada, evaluación del dolor, retorno a la actividad y fuerza de la garra medida mediante un medidor de Jamar.…”