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

Abstract

Background Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to “unload” the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease. This is a single-cut osteotomy with single-screw stabilization. Patients and Methods We have performed this technique in three cases. We present a case of a 26-year-old male who presented with a 1-year history of pain in his right wrist. Radiology performed demonstrated lunate sclerosis. Diagnostic arthroscopy revealed healthy articular surfaces. Single osteotomy capitate shortening was performed with an oscillating saw and fixed with a single cannulated compression screw. A shortening of 1.5mm was obtained with this technique. Results At 1- to 2-year follow-up, all three patients had considerable pain relief but did not have a complete resolution of pain. There was a significant improvement in function and grip strength. There have been no cases with infection, nonunion, avascular necrosis or a need for a salvage procedure. Conclusion The simplified technique of capitate shortening is easy to perform, less traumatic to the capitate vascularity, and leads to good short-term functional results.

Kienböck’s disease: preventing disease progression in early-stage disease

“…A lateral closing wedge osteotomy can combine shortening with reduction of radial inclination in ulnar negative variance wrists, or just decrease radial inclination in cases of neutral or positive ulnar variance (Figure 2). The single cut osteotomy produces shortening by a single and oblique cut proximal to the DRUJ, and is fixed with a pre-drilled screw entering from the radial styloid (Bain et al., 2020) (Figure 3). The biplanar, step-cut or Z-osteotomy allows a two-plane correction, reducing radial inclination and increasing the lunate covering ratio.…”

“…Other reasons include the paucity of published data, the potential negative effect on midcarpal alignment and the risk of endangering the blood supply of the proximal pole of the capitate, although there is no evidence to support the two latter considerations. The unloading effect of this osteotomy may decrease the risk of lunate fractures when the bone becomes avascular and weaker, protect it during possible natural revascularization and favour revascularization secondary to regional wrist hyperaemia (Bain et al., 2020).…”

“…CSO is indicated when KD occurs in ulna positive wrists, and may also be indicated in neutral variance (Almquist, 1986). The best outcomes of the procedure are expected in the early stages of the disease, when the lunate height is still maintained (Hegazy et al., 2021) and the lunocapitate joint surface is found to be preserved on arthroscopic examination (Bain et al., 2020).…”

“…CSO at the level of the STT joint can be done in isolation or combined with other procedures, such as wrist arthroscopy (Bain et al., 2020), capitohamate fusion (to prevent proximal migration of the distal carpal row) (Almquist, 1986), hamate shortening (Rabarin et al., 2010) and vascularized lunate grafting (Hegazy et al., 2021) when the lunate height is collapsed.…”

“…Plates, Kirschner wires, staples or screws have been used as fixation methods for both types of osteotomies, with no reported cases of nonunion. Pain, grip strength and functional improvement are usually expected after the procedure, and better outcomes when the procedures are done in the earlier stages (Bain et al., 2020; Hegazy et al., 2021).…”