Radial oblique osteotomy for treatment of Kienböck disease

Abstract

Background The association of ulnar minus variance with Kienbock disorder led to interest in joint-levelling surgical procedures. In this study, long-term results of an oblique radial osteotomy in Kienbock stage II and III-A, without consideration of ulnar variance, either before or after osteotomy, were analyzed. Methods We retrospectively reviewed eight patients who were treated with an oblique radial osteotomy without consideration of ulnar variance. All eight patients had their index surgery for symptomatic Kienbock disease. Six patients had Lichtman stage II and two had stage III-A. Outcome parameters included pain, range of motion, grip-strength, radiographic results in terms of Stahl-index, Lichtman-classification and ulnar variance. Results The average follow-up was 8.3 years. No postoperative infections, delayed unions or soft-tissue problems were found. The plate was removed in three patients. Pain and function improved in all patients. A difference from minus 0.76 mm to 1.86 mm positive in mean ulnar variance was found. The Stahl-index remained the same. Radiographically, no deterioration was seen in the lunate or Lichtman classification. Conclusions An oblique radial shaft osteotomy seems a successful treatment option for Kienbock disease.