Download PDF
J Wrist Surg 2019; 08(03): 226-233
DOI: 10.1055/s-0039-1683931
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Kienböck's Disease Treated by Camembert Osteotomy at Seven Years

Emmanuel J. Camus
1   SELARL Chirurgie de la Main, Clinique Du Val de Sambre, Maubeuge, France
2   ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
,
Luc Van Overstraeten
2   ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
3   Hand Foot Surgery Unit, Tournai, Belgium
› Author Affiliations
Further Information

Publication History

26 November 2018

04 February 2019

Publication Date:
25 March 2019 (online)

    Permissions and Reprints

Abstract

In 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.

Keywords

Kienböck's disease - radius - osteotomy - Camembert
 

  • References

  • 1 Dautel G. Treatment of Kienböck's disease. Round Table.33rd GEM-SFCM meeting. La Main 1999; 4: 143-71
    PubMedSearch in Google Scholar
  • 2 Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br 2008; 90 (02) 133-139
    CrossrefPubMedSearch in Google Scholar
  • 3 Salmon J, Stanley JK, Trail IA. Kienböck's disease: conservative management versus radial shortening. J Bone Joint Surg Br 2000; 82 (06) 820-823
    CrossrefPubMedSearch in Google Scholar
  • 4 Weiss AP, Weiland AJ, Moore JR, Wilgis EF. Radial shortening for Kienböck disease. J Bone Joint Surg Am 1991; 73 (03) 384-391
    CrossrefPubMedSearch in Google Scholar
  • 5 Garcia-Elias M, An KN, Cooney WP, Linscheid RL. Lateral closing wedge osteotomy for treatment of Kienböck's disease. A clinical and biomechanical study of the optimum correcting angle. Chir Main 1998; 17 (04) 283-290
    PubMedSearch in Google Scholar
  • 6 Nakamura R, Tsuge S, Watanabe K, Tsunoda K. Radial wedge osteotomy for Kienböck disease. J Bone Joint Surg Am 1991; 73 (09) 1391-1396
    CrossrefPubMedSearch in Google Scholar
  • 7 Gomis R, Martin B, Idoux O, Chammas M, Allieu Y. [Kienböck disease: treatment by shortening osteotomy of the radius]. Rev Chir Orthop Repar App Loc 1994; 80 (03) 196-204
    PubMedSearch in Google Scholar
  • 8 Waitayawinyu T, Chin SH, Luria S, Trumble TE. Capitate shortening osteotomy with vascularized bone grafting for the treatment of Kienböck's disease in the ulnar positive wrist. J Hand Surg Am 2008; 33 (08) 1267-1273
    CrossrefPubMedSearch in Google Scholar
  • 9 Rabarin F, Saint Cast Y, Cesari B, Raimbeau G, Fouque PA. [Capitate osteotomy in Kienböck's disease in twelve cases.Clinical and radiological results at five years follow-up]. Chir Main 2010; 29 (02) 67-71
    CrossrefPubMedSearch in Google Scholar
  • 10 Moritomo H. Wrist biomechanics as applied to the lunate and Kienböck's disease. In: Lichtman DM, Bain GI. , eds. Kienböck's Disease. Advances in Diagnosis and Treatment. Switzerland: Springer; 2016: 41-51
    Search in Google Scholar
  • 11 Moritomo H, Murase T, Yoshikawa H. Operative technique of a new decompression procedure for Kienböck disease: partial capitate shortening. Tech Hand Up ExtremSurg 2004; 8 (02) 110-115
    PubMedSearch in Google Scholar
  • 12 Camus EJ, Van Overstraeten L. Surgical technique of a radial wedge “Camembert” osteotomy in Kienböck disease. Tech Hand Up ExtremSurg 2012; 16 (02) 75-79
    PubMedSearch in Google Scholar
  • 13 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
    CrossrefPubMedSearch in Google Scholar
  • 14 Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the single assessment numeric evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery. Am J Sports Med 1999; 27 (02) 214-221
    CrossrefPubMedSearch in Google Scholar
  • 15 Williams GN, Taylor DC, Gangel TJ, Uhorchak JM, Arciero RA. Comparison of the single assessment numeric evaluation method and the Lysholm score. ClinOrthopRelat Res 2000; (373) 184-192
    PubMedSearch in Google Scholar
  • 16 Lee CH, Choi WS, Kim SJ, Kim JH, Lee KH. Correlation between patient-rated outcome questionnaire and single assessment numerical evaluation score in the fracture of distal radius. J Hand Surg Am 2018; 43 (Suppl. 02) SS37-SS38
    PubMedSearch in Google Scholar
  • 17 Sennwald GR, Lauterburg M, Zdravkovic V. A new technique of reattachment after traumatic avulsion of the TFCC at its ulnar insertion. J Hand Surg [Br] 1995; 20 (02) 178-184
    CrossrefPubMedSearch in Google Scholar
  • 18 Lichtman DM, Pientka II WF, Bain GI. Kienböck Disease: A New Algorithm for the 21st Century. J Wrist Surg 2017; 6 (01) 2-10
    PubMedSearch in Google Scholar
  • 19 Hulten O. Uber Anatomische variationen Der Hand-gelenkknochen: Ein beitrag zur kenntnis der genesezwei verschiedener mondbeinveranderungen. Acta Radiol Scand 1928; 9: 155-168
    CrossrefPubMedSearch in Google Scholar
  • 20 Bain GI, Begg M. Arthroscopic assessment and classification of Kienbock's disease. Tech Hand Up Extrem Surg 2006; 10 (01) 8-13
    CrossrefPubMedSearch in Google Scholar
  • 21 Bosisio MR, Talmant M, Skalli W, Laugier P, Mitton D. Apparent Young's modulus of human radius using inverse finite-element method. J Biomech 2007; 40 (09) 2022-2028
    CrossrefPubMedSearch in Google Scholar
  • 22 Mow VC, Huiskes R. Basic Orthopaedic Biomechanics and Mechano-Biology. 3rd Ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: 453-454
    Search in Google Scholar
  • 23 Ledoux P, Lamblin D, Wuilbaut A, Schuind F. A finite-element analysis of Kienbock's disease. J Hand Surg Eur Vol 2008; 33 (03) 286-291
    CrossrefPubMedSearch in Google Scholar
  • 24 Anderson DD, Deshpande BR, Daniel TE, Baratz ME. A three-dimensional finite element model of the radiocarpal joint: distal radius fracture step-off and stress transfer. Iowa Orthop J 2005; 25: 108-117
    PubMedSearch in Google Scholar
  • 25 Edwards WB, Troy KL. Finite element prediction of surface strain and fracture strength at the distal radius. Med Eng Phys 2012; 34 (03) 290-298
    CrossrefPubMedSearch in Google Scholar
  • 26 Richard F, Villars M, Thibaud S. Comportement viscoélastique du cartilage articulaire humain normal et arthrosique: modélisation et caractérisation à l'aide d'essais d'indentation instrumentée. Ècongrès Français Mécanique. Available at: http://documents.irevues.inist.fr/bitstream/handle/2042/52735/a_X27S34ZP.pdf?sequence=1 . 2013
    PubMed
  • 27 Bae WC, Ruangchaijatuporn T, Chang EY. , et al. MR morphology of triangular fibrocartilage complex: correlation with quantitative MR and biomechanical properties. Skeletal Radiol 2016; 45 (04) 447-454
    CrossrefPubMedSearch in Google Scholar
  • 28 Watson HK, Guidera PM. Aetiology of Kienböck's disease. J Hand Surg [Br] 1997; 22 (01) 5-7
    CrossrefPubMedSearch in Google Scholar
  • 29 Camus EJ. Aspect biomécanique et conséquences des arthrodèses intra-carpiennes. In: Herzberg G. ed. Arthrose Péri-Scaphoïdienne. France: Sauramps medical–Montpellier; 2006: 165-177
    Search in Google Scholar
  • 30 Matsushita K, Firrell JC, Tsai TM. X-ray evaluation of radial shortening for Kienböck's disease. J Hand Surg Am 1992; 17 (03) 450-455
    CrossrefPubMedSearch in Google Scholar
  • 31 Thienpont E, Mulier T, Rega F, De Smet L. Radiographic analysis of anatomical risk factors for Kienböck's disease. Acta Orthop Belg 2004; 70 (05) 406-409
    PubMedSearch in Google Scholar
  • 32 van Leeuwen WF, Janssen SJ, Ring D. Radiographic progression of Kienböck disease: radial shortening versus no surgery. J Hand Surg Am 2016; 41 (06) 681-688
    CrossrefPubMedSearch in Google Scholar
  • 33 Afshar A, Eivaziatashbeik K. Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. J Hand Surg Am 2013; 38 (02) 289-296
    CrossrefPubMedSearch in Google Scholar
  • 34 Calfee RP, Van Steyn MO, Gyuricza C, Adams A, Weiland AJ, Gelberman RH. Joint leveling for advanced Kienböck's disease. J Hand Surg Am 2010; 35 (12) 1947-1954
    CrossrefPubMedSearch in Google Scholar
  • 35 Camus EJ, Millot F, Larivière J, Rtaimate M, Raoult S. Le carpe à double cupule: illustration de la géométrie variable du carpe. Chir Main 2008; 27 (01) 12-19 . doi: 10.1016/j.main.2007.10.005
    CrossrefPubMedSearch in Google Scholar
  • 36 Tolat AR, Sanderson PL, De Smet L, Stanley JK. The gymnast's wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg [Br] 1992; 17 (06) 678-681
    CrossrefPubMedSearch in Google Scholar