Ostéotomie d’accourcissement du capitatum pour les stade IIIA de maladie de Kienböck. Revue d’une série de 10 poignets avec un recul minimum de 5 ans

Abstract

Treatment for Kienböck's disease is still controversial, and even more in case of positive or neutral ulnar variance. Our objective was to assess the long-term clinical and radiological outcome of capitate shortening for patients with stage IIIA disease. Between 2002 and 2008, 11 patients (10 male, 1 female) were operated on in our center. Their average age was 40 years (23 to 66), 9 were active manual workers. Dominant side was involved in 7 cases. All patients had a stage IIIA disease based on Lichtman's criteria, with a neutral or positive ulnar variance and a type I lunate according to Viegas's classification. Surgical procedure, performed under regional anesthesia, with brachial tourniquet, and fluoroscopic control, consisted of a transverse osteotomy with a 2 mm shortening of the capitate through a longitudinal dorsal approach. Fixation was carried out by one or two memory staples. A retrospective assessment was carried out by an independent observer in 2013, with clinical examination, radiological PA and lateral views. Clinical outcome measures included the QuickDASH, Modified Mayo Wrist Score (MMWS), Visual Analogue Scale (VAS) ratings of wrist/pain function, wrist motion, grip strength and patient's satisfaction. A modified Wilcoxon signed rank test was used to compare quantitative data. Only 1 patient was lost of view, follow-up ranged from 5 to 11 years (mean 8) for the 10 others patients. There was no post-operative complication, all patients has resumed their former activities except one who has received a professional reclassification. MMWS was 81.5 (70–95) and QuickDASH was 21.6 (0–47) at review but pre-operative scores were not available. The average wrist flexion/extension arc increased from 70° pre-operatively to 90° at review (P = 0.1398), average grip strength increased from 22 (50% of the contralateral side) to 36 (84%) (respectively P = 0.0078 and P = 0.0057). VAS wrist pain decreased from 7.8 (7–9) to 1.8 (0–5) (P = 0.0055). Radiographic disease progression occurred only in 2 wrist, rated stage IIIB, at 8 and 10 years follow-up without a bad clinical outcome (MMWS 90 et 80). Seven patients were very satisfied and 3 satisfied. Based upon our experience, we recommend capitate shortening for symptomatic stage IIIA disease with positive or neutral ulnar variance and Viegas's type I lunate.