Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck's Disease

Abstract

BackgroundRadius osteotomies showed favorable clinical outcome in Kienböck's disease. However, few articles have been published on the long-term outcome of lateral wedge osteotomy of the radius in patients with advanced stage Kienböck's disease.MethodsEleven patients with Lichtman stage IIIB/IV Kienböck's disease (group A; mean follow-up period, 86.1 months; range, 48 to 163 months) and 14 patients with Lichtman stage IIIA Kienböck's disease (group B; mean follow-up period, 85.1 months; range, 49 to 144 months) underwent radial wedge osteotomy between August 2004 and August 2012. Radiological changes of the lunate and radiocarpal joint were compared between two groups after osteotomy. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were evaluated preoperatively and at the final follow-up. The Nakamura Scoring System (NSSK) was used for comprehensive understanding of radiological and clinical outcomes.ResultsNine patients of group A and 11 patients of group B showed radiological improvement in the lunate regarding sclerosis, cystic changes, or fragmentation. No patients showed progression of arthritic changes in radiocarpal and midcarpal joints. The wrist flexion/extension angle, grip strength, and DASH score were significantly improved in both groups after operation, but intergroup difference was not statistically significant at the final follow-up (p = 0.149, p = 0.267, and p = 0.536, respectively). The mean NSSK was 21.6 (range, 15 to 27) in group A and 21.8 (range, 15 to 26) in group B.ConclusionsRadial wedge osteotomy yielded excellent radiological and functional outcomes in advanced stages of Kienböck's disease and these results were comparable to those of Lichtman stage IIIA disease. This technique could be a useful alternative to salvage procedures in the treatment of Lichtman stage IIIB/IV Kienböck's disease without severe radiocarpal arthritis.

The Natural History of Kienböck’s Disease Diagnosed at More than 50 Years of Age

“… 21) The most widely used diagnostic tool would be plain radiography to measure Stahl index, carpal height ratio, and scapholunate angle. Absence of sclerotic or cystic changes and of fragmentation, 22) and normalization of the trabecular patterns inside the lunate 23) have also been related to favorable treatment outcome. Lastly, lunate tenderness to palpation can be checked for both diagnosis and treatment monitoring in physical examination, 24) where its disappearance could be found in our consecutive series at the last follow-up visits.…”

Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years

“…Kienböck disease, defined as avascular necrosis of the lunate, could lead to carpal collapse and osteoarthritis of the wrist at the final stage (Beckenbaugh et al., 1980; Keith et al., 2004). Several surgical treatment options have been developed to alleviate pain, improve function, and prevent the progression of this disease (Beredjiklian, 2009; Shin et al., 2017).…”

Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

“…Разработано множество способов лечения указанного заболевания, ни один из которых не позволяет добиться стабильно хороших результатов [6]. С этой целью выполняются различные варианты костной пластики кровоснабжаемыми и некровоснабжаемыми трансплантатами, пересаживаемыми как в свободном, так и в несвободном варианте, в том числе с использованием стволовых мезенхимальных клеток, остеотомий лучевой и головчатой костей, частичного или тотального артродеза кистевого сустава, его эндопротезирования либо пластики полулунной кости костным цементом [6,7,8,9,10,11,12,13,14,15,16,17,18]. Во многом тактика оперативного лечения основана на рентгенологической картине изменений самой полулунной кости и близлежащих костей кистевого сустава.…”

“…В 1977 г. D.M. Lichtmann с соавторами, модифицировав классификацию F. Stahl, описали четыре стадии прогрессирования заболевания [19,20]. Соответственно, при наличии II-IIIa стадий болезни наиболее распространенным вариантом оперативного вмешательства в мире остается укорачивающая остеотомия лучевой кос ти [10,14,21].…”