The Results of Radial Shortening Osteotomy for Kienbock Disease Stage III

Kang,  Ho Jung; Kim,  Do Yeon; Lee,  Jeong Gil; Choi,  Yoon Rak; Hahn,  Soo Bong

Journal of the Korean Society for Surgery of the Hand 2009;14(3):102-112.
Published online September 1, 2009.

Ho Jung Kang, Do Yeon Kim, Jeong Gil Lee, Yoon Rak Choi, Soo Bong Hahn

Department of Orthopedic Surgery, Yonsei University College of Medicine Seoul, Korea. kangho56@yuhs.ac

Abstract

Purpose
Radial shortening osteotomy and ulnar lengthening osteotomy for decreasing axial loading have been known to treatment for avascular necrosis of lunate bone. The purpose of this study was to evaluate the clinical outcomes of radial shortening osteotomy for Lichtman stage III Kienbock disease. MATERIALS AND METHODS: Between December 2001 and October 2008, thirteen patients with Kienbock disease underwent a radial shortening osteotomy at our institution. On the basis of Lichtman classification, six had stage IIIA and seven had stage IIIB. Radiographic measurement of the ulnar variance and the carpal height ratio were assessed preoperatively and at the follow-up. Patients were examined for wrist pain, range of motion at flexion and extension and grip strength both preoperatively and postoperatively. The clinical outcomes was evaluated through the modification of Evans scoring system.

Results
All thirteen had maintained the preoperative stage at the follow-up. In ulnar variance, negative variance was seven. The carpal height ratio was increased mean 0.018 at the follw-up. Pain in VAS was improved mean 3.6 at the follow-up. In range of motion of wrist flexion-extension, in the eleven which had limitation of motion preoperatively, all eleven showed improvement. In grip strength, among the ten which had decreased preoperatively, eight showed improvement and two showed no change at the follw-up. The clinical outcomes were good in eight, fair in three and poor in two. Among the five, negative ulnar variance of stage IIIB, three had good, two had fair clinical outcomes.

Conclusions
We found that radial shortening osteotomy can prevent disease progression, also show good clinical results for stage IIIB Kienbock disease as well as stage IIIA.