Double V-shaped Cancellous Osteotomy of the Distal Radius for Kienböck's Disease

Abstract

Treatments of Kienböck's disease range from conservative measures-usually immobilization during the acute phase-to such procedures as joint leveling by radial shortening or ulnar lengthening, intercarpal fusion, silastic arthroplasty, and vascularized bone grafts. Joint-leveling procedures have many complications such as nonunion, hardware problems, and pain. In this study, 34 patients with Kienböck's disease, stage 1 through 3B in Lichtman's classification, were treated with a new technique: a double V-shaped metaphyseal osteotomy of the distal radius and dorsal tilt of the distal radius. The patients were evaluated clinically regarding pain, which decreased in 88% of patients; range of motion, which improved in all patients; and grip strength, which improved by 90%. Progression of the disease was assessed radiologically by determining the carpal height ratio and the carpal ulnar distance ratio. There were no cases with nonunion of the radial osteotomy at follow-up. This procedure is an effective treatment method for Kienböck's disease in wrists that do not have degenerative changes in the adjacent carpal joints.