Clin Orthop Surg.  2017 Sep;9(3):355-362. 10.4055/cios.2017.9.3.355.

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

• Shin YH
• Kim J
• Gong HS
• Rhee SH
• Cho MJ
• Baek GH

• KMID: 2412273
• DOI: http://doi.org/10.4055/cios.2017.9.3.355

Abstract

BACKGROUND
Radius osteotomies showed favorable clinical outcome in Kienböck's disease. However, few articles have been published on the long-term outcome of lateral wedge osteotomy of the radius in patients with advanced stage Kienböck's disease.
METHODS
Eleven patients with Lichtman stage IIIB/IV Kienböck's disease (group A; mean follow-up period, 86.1 months; range, 48 to 163 months) and 14 patients with Lichtman stage IIIA Kienböck's disease (group B; mean follow-up period, 85.1 months; range, 49 to 144 months) underwent radial wedge osteotomy between August 2004 and August 2012. Radiological changes of the lunate and radiocarpal joint were compared between two groups after osteotomy. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were evaluated preoperatively and at the final follow-up. The Nakamura Scoring System (NSSK) was used for comprehensive understanding of radiological and clinical outcomes.
RESULTS
Nine patients of group A and 11 patients of group B showed radiological improvement in the lunate regarding sclerosis, cystic changes, or fragmentation. No patients showed progression of arthritic changes in radiocarpal and midcarpal joints. The wrist flexion/extension angle, grip strength, and DASH score were significantly improved in both groups after operation, but intergroup difference was not statistically significant at the final follow-up (p = 0.149, p = 0.267, and p = 0.536, respectively). The mean NSSK was 21.6 (range, 15 to 27) in group A and 21.8 (range, 15 to 26) in group B.
CONCLUSIONS
Radial wedge osteotomy yielded excellent radiological and functional outcomes in advanced stages of Kienböck's disease and these results were comparable to those of Lichtman stage IIIA disease. This technique could be a useful alternative to salvage procedures in the treatment of Lichtman stage IIIB/IV Kienböck's disease without severe radiocarpal arthritis.

Keyword

Osteonecrosis; Kienböck's disease; Radius osteotomy; Radial wedge osteotomy

MeSH Terms

Adolescent
Adult
Female
Humans
Male
Middle Aged
Osteonecrosis/diagnostic imaging/*surgery
Osteotomy/*methods
Radiography
Radius/diagnostic imaging/*surgery
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 The preoperative T1-weighted magnetic resonance imaging (A) and posteroanterior (PA) radiograph (B) of a 51-year-old woman show stage IIIA Kienböck's disease in the left wrist. (C) The 5-year postoperative PA radiograph shows a decreased sclerotic lesion in the lunate. (D) The PA radiograph taken at the last visit at postoperative 11 years shows that the morphology of the lunate became nearly normalized. The bony trabecular pattern inside the lunate was similar to surrounding carpal bones. No progression of arthritic changes was visible in the radiocarpal and midcarpal joints.

• 

  Fig. 2 The preoperative posteroanterior (PA) radiograph (A) and lateral radiograph (B) of a 15-year-old man show stage IIIB Kienböck's disease in the left wrist. Six-year postoperative PA radiograph (C) and lateral radiograph (D). Radiological improvement and height restoration were observed in the diseased lunate. No development of arthritic changes was visible in the radiocarpal and midcarpal joints. The photographs of the wrist in active volar flexion (E) and in active dorsiflexion (F) show a similar range of motion of the wrist joint compared to the contralateral side.

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