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J Wrist Surg
DOI: 10.1055/s-0044-1787540
Special Review Article

Distal Radius Osteotomies for Kienbock's Disease—A Minimally Invasive Approach

Gregory I. Bain 
1   Department of Orthopaedic Surgery, Flinders Medical Centre and Flinders University, Adelaide, South, Australia
,
Sathya Vamsi Krishna 
2   Hand Surgery Unit, Department of Orthopaedic, Trauma and Spine Surgery, Narayana Health City, Bangalore, Karnataka, India
,
Simon MacLean 
3   Department of Orthopaedic Surgery, Tauranga Hospital, Tauranga, New Zealand
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Abstract

Background Negative ulnar variance is a recognized predisposing factor for Kienbock's disease (KD). Radial shortening osteotomy (RSO) reduces radial height, thereby alleviating stress on the lunate. Conversely, radial closed wedge osteotomy (RCWO) involves removing a distal radius wedge to not only decrease radial height but also reduce radial inclination, thereby enhancing lunate coverage.

Description This article outlines a straightforward and minimally invasive approach to RSO utilizing a single cut and stabilization with a single screw. Additionally, it introduces a technique for RCWO comprising two cuts, wedge removal from the distal radius, and fixation using a single headless screw.

Literature Review Traditionally, RSO and RCWO procedures include a volar approach consistent with distal radius fracture fixation techniques. However, the reliance on “free-hand” cuts may necessitate larger hardware for stabilization. Overcorrection poses risks of suboptimal outcomes and often mandates subsequent hardware removal procedures.

Clinical Relevance Both RSO and RCWO techniques offer minimally invasive solutions, which preserve the periosteum, and maintain stability. These techniques only require a single screw and a removable splint. RSO is indicated for KD wrists with negative ulnar variance, while RCWO is preferable for cases with negative ulnar variance and increased radial inclination.

Keywords

radial shortening osteotomy - Kienbock's disease - lunate unloading - single screw shortening osteotomy - radial closed wedge osteotomy


Publication History

Received: 01 April 2024

Accepted: 16 May 2024

Article published online:
28 August 2024

© 2024. Thieme. All rights reserved.

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