Radial Shortening Osteotomy in Advanced Stages of Kienbock Disease

Abstract

Radial shortening osteotomy is a well-accepted treatment for Kienbock disease in stages I to IIIA. The usefulness of this procedure in more advanced stages of the disease is controversial. In this study, 27 cases of stage IIIB and IV of Kienbock disease underwent radial shortening osteotomy and were followed for a mean period of 54.9 months (9 to 117 mo). Twenty-four patients had stage IIIB and 3 patients had stage IV disease. Sixteen of the affected wrists were on the dominant side. All patients were evaluated clinically and radiologically at last follow-up. Modified Mayo Score was used for clinical evaluation. The measured radiologic parameters included carpal height ratio, Stahl index, and radioscaphoid angle. In stage IIIB, 41.6% of cases had good, 54.2 had fair, and 4.2 had poor result, whereas in stage IV all patients showed poor result. The mean range of flexion-extension was 84.4% of the unaffected side. Considering the percentage of preserved motion, this procedure seems to be a good alternative to partial fusion for stage IIIB when the patient is willing to preserve more degrees of motion. Although the number of patients with stage IV disease was limited in this study, poor result in all of them may show the uselessness of this procedure in stage IV.

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

“… 7 11 12 13 14 15) Thus, the efficacy of radial osteotomies in advanced stages of Kienböck's disease has been controversial and salvage procedures have been recommended in these stages. 8 10) However, salvage procedures, such as proximal row carpectomy, limited carpal fusion, and wrist arthrodesis reduce the wrist ROM. 3 8 9 10) In addition, these salvage procedures could not halt the secondary arthritic changes in the radiocarpal and other joints around the wrist, despite symptomatic relief.…”

“… 8 10) However, salvage procedures, such as proximal row carpectomy, limited carpal fusion, and wrist arthrodesis reduce the wrist ROM. 3 8 9 10) In addition, these salvage procedures could not halt the secondary arthritic changes in the radiocarpal and other joints around the wrist, despite symptomatic relief. 9 10 25 26) Radial osteotomy is a relatively simple extra-articular procedure, and surgery itself does not influence the flexion/extension of the wrist joint.…”

“… 1 6 7) However, these procedures inevitably reduce range of motion (ROM) of the wrist joint, which is considered undesirable by many patients. 3 8 9 10) …”

Kienbock Disease: A Complicated Postsurgical Case Study Using Diagnostic Ultrasonography

“…10 Radial osteotomy is an accepted treatment for patients in stage I to IIIA but has shown poor results in stage IV patients. 16 Revascularization of the lunate has been reported to accomplish improvement in range of motion and strength with excellent pain relief despite the possibility of further collapse of the lunate. 11 In our patient, the lunate demonstrated further collapse after bone grafting, which was reported in only 15% of patients after revascularization.…”

Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

“…2 This became a dogma for most hand surgeons 15 despite the good clinical results published by many authors with radial osteotomies in advanced Kienbock's disease. [16][17][18][19][20][21][22][23]…”