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

AbstractIn Kienböck's disease, radius shortening osteotomy is the most common treatment. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical symptoms and limits lunate collapse. The series include 10 patients who underwent a Camembert osteotomy for Kienböck's disease between 2002 and 2012 (one bilaterally). They are six men and four women, aged 40.6 years. Five patients had an additional ulnar shortening osteotomy if ulnar variance was neutral or positive. The mean follow-up is 7 years. Preoperatively, range of motion, grip strength, pain, and functional scores were poor. All osteotomies healed within 3 months. Extension, ulnar deviation, grip, functional scores improved significantly. In 10 cases, there were improvement in the T1 and T2 signals on the magnetic resonance imaging (MRI). There was no lunate collapse. This series shows good results with no worsening of the lunate shape. There was no ulnocarpal impingement. The Camembert osteotomy proposes to offload the lunate and redirect strains toward the scaphoid. The supposed interest is to protect the lunate from collapse. In this small series, the Camembert osteotomy improved function in patients with early stage Kienböck's disease. MRI aspects improve in most cases and no patients collapsed. Camembert can be used in combination with a Sennwald's ulnar shortening when ulnar variance is neutral or positive. Authors propose this procedure for Lichtman's stages 1–2–3A if there are no cartilage or ligament lesions. This is a Level IV, case series study.

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Radial Closing Wedge Osteotomy for Kienböck’s Disease

Kienböck’s Disease ◽

10.1007/978-3-319-34226-9_17 ◽

2016 ◽

pp. 193-197

Author(s):

Masahiro Tatebe ◽

Ryogo Nakamura ◽

Hitoshi Hirata

Keyword(s):

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Kienbock’S Disease

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Scaphotrapeziotrapezoid (STT)-Arthrodesis in Kienböck’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.03.005 ◽

2004 ◽

Vol 29 (6) ◽

pp. 580-584 ◽

Cited By ~ 41

Author(s):

R. MEIER ◽

M. VAN GRIENSVEN ◽

H. KRIMMER

Keyword(s):

Functional Result ◽

Contralateral Side ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Long Term Effect ◽

Advanced Stages ◽

The Mean ◽

Kienbock’S Disease

This study reviews the results of 59 of 84 patients with severe Kienböck’s disease who were treated with STT fusion. The average follow-up period was 4 (ranges: 2–8) years. The average arc of wrist extension and flexion was 67° (60% of the contralateral side, 81% of pre-operative range) and that of ulnar and radial deviation was 31° (52% of the contralateral side, 56% of pre-operative range). Pre-operative pain values (VAS) were 56 (non-stress) and 87 (stress) and were significantly higher than the postoperative values of 12 (non-stress) and 41 (stress). Grip strength improved from 45 kPa pre-operatively to 52 kPa postoperatively. The mean modified Mayo wrist score was 63 points. The patients reported low disability in the DASH scores, with an average of 28 points. Our data show that STT fusion is a reliable and effective treatment for pain relief and offers a good functional result in advanced stages of Kienböck’s disease. However the long-term effect of this procedure on radioscaphoid and other intercarpal joints is yet to be determined.

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Lateral closing wedge osteotomy for treatment of Kienböck's disease

Annales de Chirurgie de la Main et du Membre Supérieur ◽

10.1016/s0753-9053(98)80027-6 ◽

1998 ◽

Vol 17 (4) ◽

pp. 283-290 ◽

Cited By ~ 1

Author(s):

M. Garcia-Elias ◽

K.N. An ◽

W.P. Cooney ◽

R.L. Linscheid

Keyword(s):

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Kienbock’S Disease

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Radial Closing Wedge Osteotomy for Kienböck’s Disease: an Over 10 Year Clinical and Radiographic Follow-Up.

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0621 ◽

2002 ◽

Vol 27 (2) ◽

pp. 175-179 ◽

Cited By ~ 48

Author(s):

A. WADA ◽

H. MIURA ◽

H. KUBOTA ◽

Y. IWAMOTO ◽

Y. UCHIDA ◽

...

Keyword(s):

Long Term Results ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Closing Wedge Osteotomy ◽

Radial Inclination ◽

Closing Wedge ◽

Joint Contact ◽

Kienbock’S Disease

Thirteen patients with Kienböck’s disease who had undergone a radial closing wedge osteotomy were reviewed clinically and radiologically at a follow-up mean of 14 years. Good long-term results were obtained in all patients. Their levels of pain were improved, and significant increases were seen in the range of motion and grip strength. Radiographic stage, as assessed by Lichtman’s classification, improved in one, did not change in four, and advanced in eight patients. The radial inclination angle significantly decreased and the carpal-ulnar distance and lunate covering ratios both increased, demonstrating that radial shift in the alignment of the carpal bones occurs and that the joint contact area of the lunate increases in proportion to the decrease in radial inclination. The preoperative radiolunate and radioscaphoid angles, which were significantly larger than those of the unaffected wrist, did not change postoperatively which shows that this technique was not able to correct the flexion deformity of the lunate and the scaphoid.

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Stage 3 KienbÖck’s Disease: Reconstruction of the Fractured Lunate using a Free Vascularized Iliac Bone Graft and External Fixation

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2002.0766 ◽

2002 ◽

Vol 27 (4) ◽

pp. 369-373 ◽

Cited By ~ 28

Author(s):

M. GABL ◽

M. LUTZ ◽

Cl. REINHART ◽

R. ZIMMERMANN ◽

S. PECHLANER ◽

...

Keyword(s):

Clinical Outcome ◽

Necrotic Core ◽

Iliac Bone ◽

The Other ◽

Carpal Collapse ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Iliac Bone Graft ◽

Kienbock’S Disease

Eighteen patients with stage 3 Kienböck’s disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.

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