Temporary scaphocapitate fixation with or without radial shortening for adolescent Kienböck's disease.

Abstract

We performed temporary scaphocapitate joint fixation with or without radial shortening osteotomy, depending on the ulnar variance, in adolescent Kienböck's disease. The aim of the current study was to evaluate the radiological and clinical results and compare our results with those of other previously reported methods. Temporary scaphocapitate fixation alone or fixation accompanied by radial shortening osteotomy has been performed in three patients since 2003. All six patients were males, and their mean age at surgery was 15.5 years. The fixation was performed using two Kirschner-wires in closed methods, and the shortening of the radius was performed using the volar approach and secured with a plate. Radial shortenings of 4, 2, and 7 mm were applied. Radiological findings of Kienböck's disease, including ulnar variance and carpal height ratio, were investigated at the final follow-up by simple radiography and MRI. Clinical results of pain, range of wrist motion, and grip strength were also evaluated. The mean age at the final follow-up of six patients was 22 years, and the follow-up period was 6.8 years. Sclerosis or fragmentation of all the lunates in the simple radiographs improved, and the carpal height ratio increased to 0.5 at the final follow-up. The signal intensities on the final MRI were all normalized. The final visual analog scale scores decreased to 1.2, and wrist ranges of motion were all statistically significantly increased. In addition, grip strength increased to 69% of that of the normal side at the final follow-up. We suggest that temporary scaphocapitate joint fixation is a recommendable option with or without radial shortening, depending on the ulnar variance, in adolescent Kienböck's disease.