L’ostéotomie du capitatum dans la maladie de Kienböck. Résultats cliniques et radiologiques à cinq ans de recul moyen. À propos de 12 cas

Abstract

Kienböck's disease could occur pain and reduce wrist's range of motion despite of an early radiologic staging. Usual surgical procedures unload the lunate. Radial shortening is the common procedure in negative ulnar variance. For wrists with neutral or positive ulnar variance, this procedure could produce a distal radio-ulnar discrepancy and an ulnocarpal impingement. We perform, in these cases, a capitate shortening. The goal of this study is to relate the wrist functional outcome and the radiological result in 12 cases. It was a consecutive retrospective study of 12 patients (nine male, three female). Eight Lichtman's stage II and four stage III A with neutral or positive ulnar variance. The wrists were painful and with a reduce range of motion. The surgical procedure consisted in a dorsal approach and a 2 -mm shortening osteotomy in the capitate's waist. Bone clips were used for fixation. The follow-up average period was 65.8 months. All patients had pain relief. The wrist's range of motion improved in all cases. Any single complication was noted. The patients recovered their professional or usual occupation with an average of 3.6 months. Lunate's vascularization improved in all cases. Any intracarpal complication or capitate non-union occured. The capitate shortening is a simple and low aggressive procedure. Wrist's functional outcome has good results. We recommend this procedure for symptomatic patients in early Kienböck's disease with neutral or positive ulnar variance.