Osteotomie du capitatum dans la maladie de Kienböck (à propos de 5 cas)

Abstract

Kienbock's disease is a form of osteonecrosis affecting the lunate, which progresses through several stages if not treated. 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. Our objective was to assess the long-term clinical and radiological outcome of capitate shortening for patients with neutral or positive ulnar variance at stage II and IIIA of disease. Between 2007 and 2013, 05 patients (03 male, 02 female) were operated. Their average age was 38 years (28 to 49). Two Lichtman's stage II and three stage III A with neutral or positive ulnar variance. The surgical procedure consisted in a dorsal approach and a 2 mm shortening osteotomy in the capitate's waist. Fixation was carried out by two memory staples. The mean follow-up was 03 years (29–60 months). Clinically, all patients had improved wrist pain, wrist range of movement, and grip strength after the surgery. Radiographic disease progression occurred only in 1 wrist, rated stage IIIB, at 4 years follow-up without a bad clinical outcome. The other 4 cases have all shown signs of revascularization. Any intracarpal complication or capitate non-union occurred. Capitate shortening osteotomy has been the subject of only a few publications. It is a simple and low aggressive procedure which is indicated in case of impossibility to achieve Radius shortening osteotomy in symptomatic patients. The osteotomy must be performed delicately, 2 mm shortening is sufficient to reduce 66 % of the pressure forces in the lunate lodge. However, it might be an efficient technique to induce the revascularization process in the early stages of Kienbock's disease. The capitate shortening is a simple and low aggressive procedure. We recommend this procedure for symptomatic patients in early Kienbock's disease with neutral or positive ulnar variance.