Kienböck's disease with non-negative ulnar variance : Treatment with combined radial wedge and shortening osteotomy.

Abstract

There are only few studies that focused on Kienböck's disease with non-negative ulnar variance, even though many surgical procedures have been introduced. Acombined radial wedge and shortening osteotomy was carried out for Kienböck's disease with non-negative ulnar variance. The purpose of this article is to report the results of this procedure by analyzing the clinical and radiological data. The data for patients with Kienböck's disease who were treated by combined radial wedge and shortening osteotomy between 2007 and 2016 were retrospectively reviewed. Atotal of 18 patients (8 males, 10 females), average age 37years, were included in this study and the mean follow-up period was 22.3months. Radiological analysis included Lichtman stage, ulnar variance, radial inclination, carpal height ratio, radioscaphoid angle and Stahl's index. Clinical analysis included range of motion (ROM), visual analog scale (VAS) score, grip power, modified Mayo wrist score (MMWS), and disabilities of arm, shoulder and hand (DASH) score. Preoperative radiological analysis showed 16cases of Lichtman stage IIIA and 2cases of stage IIIB. Preoperative ulnar variance was +0.51 mm, radial inclination was 27.7o, carpal height ratio was 0.49, radioscaphoid angle was 52.8o and Stahl's index was 0.42. All patients had solid union at the osteotomy site. At the final follow-up the average ulnar variance was +1.9 mm, radial inclination was 16.5o, carpal height ratio was 0.48, radioscaphoid angle was 58.2o and Stahl's index was 0.36. Clinical analysis showed that the average dorsiflexion of the wrist was increased by 8.4o and palmar flexion of the wrist was increased by 29.6o. Grip power was increased by an average of 9.9 kg. Average VAS at the final follow-up was 1.0, DASH score was 4.3, and modified Mayo wrist score was 78.1. Radial wedge and shortening osteotomy can be recommended as an option for Kienböck's disease with non-negative ulnar variance, based on acceptable results from this study.