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

Abstract

Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion–extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock’s disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.

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

“…JLPs are currently proposed when there is an intact lunate with a negative or neutral ulnar variance or an abnormal radial inclination, or both. It is not clear whether patients with Lichtman Stages IIIA or even IIIB KD benefit from JLPs, but good long-term results have been described with the procedures (Botelheiro et al., 2019).…”

Re: Herren DB, Marks M, Neumeister S, Schindele S. Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis. J Hand Surg Eur. 2023

“…Having long ago empirically reached the conclusions of the authors, our classification of Kienbock's disease (KD) in stages IIIA (without carpal collapse) or IIIB (with carpal collapse) is done comparing to the contralateral wrist (Botelheiro et al, 2019), something the authors did not mention.…”

Re: Luitjens J, Goller SS, Schmitt R, Erber B, Van Scoonhoven J, Hess N. Diagnostic performance of traditional radiographic indices in detection of carpal collapse in Kienbock’s disease. J Hand Surg Eur. 2023, 48: 619–24.

“…Having long ago empirically reached the conclusions of the authors, our classification of Kienbock’s disease (KD) in stages IIIA (without carpal collapse) or IIIB (with carpal collapse) is done comparing to the contralateral wrist (Botelheiro et al., 2019), something the authors did not mention.…”