A Comparative Study Between 2 Intracarpal Partial Shortening Osteotomy Techniques for Type II Lunate Kienbock Disease

Abstract

Partial capitate shortening is a decompression procedure for the treatment of positive or neutral ulnar variance Kienbock disease. In 45% to 73% of population, the lunate has a separate hamate facet which is also known as a type II lunate. We hypothesized that capitate shortening alone may not ensure adequate decompression of type II lunate, therefore, an added hamate shortening was performed aiming at a better distal unloading in these situations. Thirty Kienbock patients, stage II, type II lunate, and ulna positive or neutral variance, were recruited in this study, Half of which underwent an isolated partial capitate osteotomy, while the other half underwent a combined partial capitate-hamate osteotomy. The 2 groups were matched making the osteotomy type the only variable in the study. Postoperative changes in visual analogue score, the quick Disability of the Arm Shoulder and Hand questionnaire, Stahl index, and radioscaphoid angle in lateral view radiograph were recorded. Flexion and extension range of motion using a goniometer, and grip strength using dynamometer were recorded as percentage of the contralateral normal wrist. All the patients were followed up for 18 months. The 2 groups were comparable preoperatively as regards to the clinical and radiologic parameters. Postoperatively, there was no clinical nor radiologic, statistically significant differences between the 2 groups. We conclude that either isolated capitate shortening osteotomy or combined capitate/hamate osteotomy techniques can achieve very comparable results, both with good outcomes.