Long-Term Follow-up of Radial Shortening Osteotomy With Nakamura Effect for Kienböck Disease Stage II and IIIA

Abstract

Objective: Show our results in the treatment of Kienböck disease stage II and IIIA of the Lichtman classification using a radial shortening osteotomy with Nakamura effect. Material and Methods: In all, 20 patients were evaluated with follow-up of 12 to 120 months (mean, 66 months), 14 males and 6 females between 20 to 45 years old. Eleven were with stage II and 9 with stage IIIA Kienböck disease according to the Lichtman classification. All cases were treated with a lateral metafiseal closing wedge osteotomy of the radius with Nakamura effect. We indicate this joint leveling surgery in patients with confirmed stage II or IIIA Kienböck disease with persistent symptoms, ulnar negative variance, and ulnar angle of the articular surface of the radius greater than 25°. Patients were evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion (ROM), Mayo wrist score, radiological controls, grip strength, and visual analogue scale (VAS) score. Results: In all, 20 patients were evaluated in our study, 11 with stage II and 9 with stage IIIA Kienböck disease according to the Lichtman classification. We did a lateral closing wedge osteotomy in the metafisis of the radius with Nakamura effect in all patients. ROM was 92% compared with the contralateral limb. Mayo wrist score mean was of 90 points. The overall results were 5 excellent and 6 good for patients with stage II Kienböck disease, and 4 excellent and 5 good in patients with stage IIIA. All of them returned to normal work and daily living activities and to sports activities as well. Possible complications of this treatment are delayed union or nonunion, ulnar impaction or infection, but we did not have any of them in our group of patients. Conclusion: We present the results of 20 patients with stage II and IIIA Kienböck disease according to Lichtman scale who were treated using a lateral closing wedge osteotomy of distal radius with Nakamura effect. The objective of this surgery is to produce a radial shortening, a decrease in the ulnar tilt of the articular surface of the radius to 20°, a decrease in Lunate strain, and to produce a “vascular shock” near the necrotic Lunate. Patients were evaluated with DASH score, ROM, Mayo wrist score, grip strength, and VAS score. We achieve 100% between good and excellent results with a 45% of excellent outcome and 55% of good outcome. According to these results, we believe radial shortening osteotomy with Nakamura effect is a reliable technique for the treatment of Kienböck disease stage II and IIIA of Lichtman classification. This procedure is technically straightforward with limited risks, its results are comparable with more significant procedures, it saves the Lunate, and we found limited arthritic changes in a few cases.