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J Wrist Surg 2016; 05(02): 092-097
DOI: 10.1055/s-0036-1581099
Special Focus Section: Kienböck Disease
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-Term Outcomes of Radial Osteotomy for the Treatment of Kienböck Disease

Masahiro Tatebe
1   Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
,
Sukuki Koh
2   Hand Department, Japanese Red Cross Hospital Nagoya Daiichi, Nagoya, Japan
,
Hitoshi Hirata
1   Department of Hand Surgery, Nagoya University School of Medicine, Nagoya, Japan
› Author Affiliations
Further Information

Publication History

13 January 2016

27 February 2016

Publication Date:
01 April 2016 (online)

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Abstract

Background Kienböck disease is an aseptic necrosis of the lunate of unknown etiology, prevalent in young adults. Treatment aims to lower forces on the lunate, decrease pain and improve function. We conducted a retrospective evaluation of the 10-year clinical and radiological outcomes of radial osteotomy as a treatment for Kienböck disease.

Materials and Methods We analyzed pain, grip strength, wrist range of motion (ROM), radiological carpal geometry, and staging of osteoarthritic changes over a 10-year period, postosteotomy, for 18 patients. The Mayo wrist score was used as an overall measure of outcome.

Technique Outcomes for two types of osteotomies were included, a step-cut osteotomy with fixed screws and an updated technique of two linear transverse osteotomies with volar locking plates. For cases with negative ulnar variance, resection of the radius was included to obtain a final ulnar variance of −1 to 0 mm. For positive ulnar variance, the goal was to obtain a correction of radial inclination of 10 to 15 degrees.

Results Improvements in pain, ROM, and grip strength were maintained over the 10-year follow-up, without radiological improvement in geometry (carpal height ratio and Stahl index). Mild osteoarthritic changes were identified in 33% of patients, with no effect on clinical results. Degree of cartilage damage determined postoperative grip strength improvement. The Mayo wrist score at the final follow-up was excellent in one patient, good in nine, and fair in eight.

Conclusions Radial osteotomy provides reasonable and long-term clinical benefits. Preoperative arthroscopic evaluation of cartilage damage can inform treatment decisions.

Keywords

Kienböck disease - radial osteotomy - long-term outcome - lunate - arthroscopy
 

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