Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease

Radial shortening osteotomy (RSO) as treatment for Kienböck’s disease usually improves patient symptoms for several years. Four small series have also shown that the effect may last for decades, but only two studies have used a patient-based assessment. We examined 16 patients, with a mean age at operation of 32 years, evaluating clinical and radiological results at a mean 25 (range 20 to 33) years after surgery. Three patients had progressive lunate collapse, of whom one patient needed a silicone implant arthroplasty 2 years after RSO and one patient a wrist fusion 16 years after RSO. The time between onset of symptoms and osteotomy in the remaining 14 patients averaged 20 months. The mean VAS for pain was 0.9 at rest, 0.9 with unloaded motion, 1.7 with slight, and 3.0 with heavy exertion. Two patients had marked wrist pain. Compared with the contralateral wrist the mean range of motion was 88%, grip strength was 95%, and key pinch 107%. The Disabilities of the Arm, Shoulder, and Hand score averaged 6.1, and the Mayo wrist score, 79.3. The Lichtman stage remained unchanged in 56% of patients. The inner structure of the lunate improved in all patients, and its shape remained unchanged in half of the cases. Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease.

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Functional and radiological results of partial capitate shortening osteotomy in the treatment of Kienböck’s disease

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420905991 ◽

2020 ◽

Vol 45 (4) ◽

pp. 403-407 ◽

Cited By ~ 1

Author(s):

Abdurrahman Murat Yıldırım ◽

Ahmet Piskin ◽

Bedri Karaismailoglu ◽

Muhittin Sener

Keyword(s):

Return To Work ◽

Level Of Evidence ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Pain Scores ◽

Radiological Results ◽

Shortening Osteotomy ◽

The Mean ◽

Functional And Radiological Results ◽

Kienbock’S Disease

This study assessed the functional and radiological results of partial capitate shortening osteotomy in the treatment of Lichtman stage 2 and 3A Kienböck's disease. Nineteen patients who underwent partial capitate shortening osteotomy between 2014 and 2017 were included. Functional and radiological parameters were assessed both pre- and postoperatively. The mean age was 35 years and the mean follow-up was 16 months. Pain scores, wrist range of motion, hand and finger strength, carpal height ratio and lunate height were significantly improved compared with their preoperative values. Sixteen patients were able to return to work. Ten of them had complete and six had partial revascularization. The mean time taken to return to work was 62 days. No vascularity was achieved in three patients who were unable to return to work. Partial capitate shortening osteotomy is effective in the treatment of stage 2 and 3A Kienböck's disease with successful results both functionally and radiologically. Level of evidence: IV

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