Wedge Osteotomy Research Articles

Dynamic, Over-Valgus Correction Without Osteotomy for Nonunion of Subtrochanteric Hip Fractures Using a Dynamic Hip Screw

Subtrochanteric nonunion is especially challenging. Extramedullary fixation using fixed-angle devices with a closing lateral wedge osteotomy is the standard surgical procedure for restoring the hip’s normal alignment and achieving bone union. However, this procedure is technically demanding and relies on devices that facilitate bone union in a non-dynamic manner, along with the limitations that this type of fixation entails, especially in this highly biomechanically stressed area. This paper aims to describe a novel surgical technique to heal subtrochanteric nonunion based on dynamic fixation performed through an over-valgus correction of the hip and fixed with a dynamic hip screw (DHS). Between March 2022 and July 2023, five patients diagnosed with nonunion of a subtrochanteric fracture were operated on by a single surgeon and followed prospectively. The average age of the patients was 64 (range: 34–85). The mean duration of surgery was 112 min (range: 63–153). The femoral neck angle before surgery was 120° (range: 110°–122°) and 147° (range: 142°–150°) after surgery. The mean leg length increased by 8 mm (range: 6–12). The Harris hip score improved from 38 points (range: 30–44) to 90 points (range: 88–96), corresponding to excellent or good results. All patients healed without major complications and were asymptomatic after 12 months of follow-up. In conclusion, over-valgus correction using a DHS is a novel technique that seems helpful for subtrochanteric nonunion. It allows for dynamic fixation, offering the advantages of dynamic fixation, especially in this high-stress area. It is also performed without osteotomy, making it a less demanding technique than the current methods described.

Bilateral, Neglected Lateral Humeral Condyle Nonunion: A Unique Case of Cubitus Valgus and Ulnar Neuropathy Successfully Treated With Combined Closed Wedge Osteotomy and Ulnar Nerve Transposition

Bilateral, Neglected Lateral Humeral Condyle Nonunion: A Unique Case of Cubitus Valgus and Ulnar Neuropathy Successfully Treated With Combined Closed Wedge Osteotomy and Ulnar Nerve Transposition

The use of four K-wires does not lead to a reduction of the MPTA in the context of a one-dimensional tibial deflection correction of patients with ACL re-rupture and pathologically increased tibial slope.

Anterior tibial closing wedge osteotomy (ATCWO) has been shown to significantly reduce failure rates of revision anterior cruciate ligament (ACL) reconstructions in patients with a posterior tibial slope (PTS) ≥12°. Recent findings suggest a slight but significant reduction of the medial proximal tibial angle (MPTA) resulting in a varus knee where the sagittal osteotomy plane is based on a total of two guide wires defining the osteotomy wedge without respecting the frontal plane. We hypothesize that the placement of a total of four guide wires intraoperatively can reduce the influence on the MPTA. This study retrospectively reports on a two-centre series of 42 ATCWOs for PTS correction between January 2022 and December 2023 at two clinical centres. A total of four guide wires were placed based on a true lateral intraoperative view of the tibia, with two positioned each at the cranial and at the caudal pole of the osteotomy wedge, serving as guides for the saw to create the osteotomy, with careful attention to ensuring that the proximal and distal K-Wires were placed parallel to each other. A retrospective analysis was conducted by examining true lateral and anteroposterior radiographs to identify changes in sagittal and coronal plane alignment. The study included 19 women and 23 men, with a mean age of 29.7 ± 8.6 years with first-time ACL revision surgery and a minimum PTS of ≥12°. PTS decreased significantly from 14.5 ± 2.8° preoperatively to 8.2 ± 1.9° post-operatively (p < 0.001). The aMPTA demonstrated no significant difference between preoperative (mean aMPTA: 86.9 ± 2.1°) and post-operative (mean aMPTA: 86.6 ± 1.9°) measurements (p > 0.05). With our technique of placing four guide wires to achieve precise guidance during the insertion of the osteotomy wedge, there is no substantial impact on the aMPTA during slope correction. Level IV.

A Minimally Invasive Surgery Technique for Closing Base Wedge Osteotomy with Fixation for Correction of Bunionette.

A Minimally Invasive Surgery Technique for Closing Base Wedge Osteotomy with Fixation for Correction of Bunionette.

Surgical Correction of Thoracic and Thoracolumbar TB Kyphosis by Posterior Only Approach Using Rajasekaran's Kyphosis Classification.

Prospective analysis of retrospective data. To analyse the clinical and radiological outcomes of thoracic and thoracolumbar TB kyphosis by a posterior-only approach using kyphosis classification. Patients with thoracic and thoracolumbar spinal TB who underwent posterior-only surgical correction for kyphotic deformity >30° were categorized into Group: A (Active TB) and Group B (Healed TB). Demographic, clinical and radiological data were collected, and kyphotic deformity was classified according to Rajasekaran classification. 52 patients with a minimum 2-year follow-up were included. Group A included 25 patients with mean preop kyphosis of 39.5° (31.2°-53.7°), and Group B included 27 patients with mean preop kyphosis of 85° (44.2°-125.2°). Among 25 patients in Group A, 19 were Type IIIA, and 6 were Type IIA kyphosis. In Group B, 18 patients were Type IIIB, 5 were Type III C, 3 were Type IIA, and 1 was IIIA kyphosis. All patients in group A underwent posterior column shortening by Smith-Peterson Osteotomy, with 14 patients requiring additional anterior column reconstruction. Patients in Group B required Closing-Opening Wedge Osteotomy (18), Halo followed by vertebral column resection (6), disc bone osteotomy (2) and pedicle subtraction osteotomy (1). Mean kyphosis at 2 years follow-up was 20.8° (11.2°-32.8°) in Group A and 53.5° (8.1°- 96.4°) in Group B. Correction of kyphosis in spinal TB involves completely different strategies in active and healed disease. Hence, a posterior-only treatment approach using Rajasekaran's kyphosis classification can help surgeons in appropriate decision-making.

Mechanical stability of the proximal tibia with different bone formations after plate removal in medial opening-wedge high tibial osteotomy: a finite element analysis

BackgroundNo clear agreement exists on the degree of bone formation required to remove a metal plate without correction loss after medial opening-wedge high tibial osteotomy (MOWHTO). We aimed to investigate the mechanical stability of the proximal tibia with different bone formations after plate removal in MOWHTO using finite element models and determine the extent of bone formation when the plate can be removed without correction loss.MethodsThe MOWHTO models with 5, 10, and 15 mm opening gaps were generated. The mechanical stability of proximal tibial models with different extents of bone formation (from the lateral cortex of the osteotomy wedge to 20% (zone 1), 40% (zone 2), 50% (zone 2.5), 60% (zone 3), 70% (zone 3.5), 80% (zone 4), and 100% bone formation medially) after plate removal was analyzed using finite element analysis. Bone stress and strain and micromotion were evaluated to investigate fracture risk and bone stability, respectively, in various types of tibial models.ResultsPeak von Mises stress was lower than yield strength when bone formation reached zone 3.5 (70%) or more in 5- and 10-mm osteotomy gap models, and zone 4 (80%) or more in a 15-mm gap model. Maximal principal strains were lower than 6,130 microstrain when bone formation reaches zone 3.5 (70%) or more in models with osteotomy gaps of 5, 10, and 15 mm.ConclusionsThis indicates that plate removal without correction loss after MOWHTO may be possible when bone formation reaches zone 3.5 (> 70%) or more during 5- and 10-mm osteotomy gap corrections, and zone 4 (> 80%) or more during 15-mm gap correction. The present study results suggest that it would be safer to perform plate removal after obtaining sufficient bone formation rather than performing it near the osteotomy gap center (50%) to avoid correction loss considering both coronal and sagittal plane aspects.

Is there a relationship between recurrence and obesity in the three-year mid-term follow-up of patients who underwent high tibial osteotomy due to medial gonarthrosis?

This study aimed to radiologically evaluate the possible relationship between the body mass index (BMI) and recurrence of varus deformity during the mid-term follow-up of patients treated for medial gonarthrosis. Fifty-six patients (11 males, 45 females; mean age: 53.8±7.2 years; range, 29 to 64 years) who underwent medial opening wedge osteotomy for the treatment of isolated medial varus gonarthrosis between January 1, 2020, and June 1, 2021, were retrospectively reviewed. Patients were categorized according to BMI values as having a healthy weight (18.5-24.9 kg/m2), being overweight (25.0-29.9 kg/m2), or being obese (≥30 kg/m2). Mechanical medial proximal tibial angle, hip-knee-ankle angle, joint line convergence angle, and knee adduction moment calculations were performed based on radiographs. Among the 56 patients, the mean age of those with healthy weight was 42.5±13.2 years, that of the overweight group was 53.3±6.4 years, and that of the obese group was 54.0±5.8 years. Radiological evaluations were statistically improved postoperatively compared to preoperative scores across BMI groups (p<0.05). There were no correlations between age and radiological scores or BMI (p>0.05). Similarly, no correlation was found between BMI and radiological scores (p>0.05). Body mass index is not of significance in medial opening wedge osteotomy radiological scores in short- and mid-term follow-up.

Early Results of Operative Treatment of Freiberg Disease Using Extra Articular Dorsal Closing Wedge Osteotomy

Early Results of Operative Treatment of Freiberg Disease Using Extra Articular Dorsal Closing Wedge Osteotomy

Computer aided multiplanar osteotomy using patient specific instrumentation to treat cubitus varus in children

Cubitus varus deformity is a common complication of supra-condylar fractures in children.Anatomic correction is the key to obtaining good functional results and avoiding later symptomatic degradation. Different techniques have been described, mainly lateral closing wedge osteotomy. A medial opening wedge osteotomy seems more intuitive, allowing an anatomic reduction, but it is technically challenging.Two-plane radiographs are too simplistic to appreciate the 3D deformity. With medical imaging and image processing advances, three-dimensional (3D) virtual models of a patient’s anatomy can be generated. Rapid 3D printing has allowed virtual simulations of surgical corrections to be transferred to real-world applications in the operating room, allowing more precise and accurate surgery with better 3D corrections.3D computer modeling with the development of customized drilling and cutting guides allows complex medial opening wedge osteotomy for correction of cubitus varus deformity in immature children with best-fit plate synthesis.Level of evidence: IV

Letter to the editor regarding “Periarticular open wedge osteotomy for severe valgus deformity and associated rearfoot talar coalitions”

Letter to the editor regarding “Periarticular open wedge osteotomy for severe valgus deformity and associated rearfoot talar coalitions”

Optimizing Reduction Guide Stability in Osteotomy Using Patient-Specific Instrumentation: A Basic Guideline.

The use of patient-specific instruments (PSIs) for osteotomies is becoming more popular in orthopaedic surgery for correcting mechanical axis and posttraumatic deformities. However, the PSI reduction guides have great potential for intraoperative deformation, which adversely affects the accuracy of the procedure. To conduct a finite element analysis (FEA) to analyze different design parameters to improve the intraoperative stability of the reduction guides. Descriptive laboratory study. A reduction guide with a rectangular cross section and four 4-mm K-wire slots was simplified, and the following parameters were modified: width, height, profile design, K-wire thickness, and positions. Bending and torsional moments were applied to the guide construct and guide deformation and equivalent stress were determined using FEA. Increasing the profile height by 25% resulted in a 44% reduction in guide deformation for bending (37% for torsion). A 25% increase in profile width led to an 18% deformation reduction for bending (22% for torsion). Transverse K-wire slots resulted in 51% less deformation in torsion compared with longitudinally oriented slots. Placing the central K-wire slots 25% closer to the osteotomy reduced guide deformation by 20% for bending and 11% for torsion. The most effective methods to increase reduction guide stability are to increase the guide height and reduce the central K-wire distance to the osteotomy. When performing opening or closing wedge osteotomies, which mainly involve bending of the guide, a high-profile guide and longitudinally oriented K-wire slots should be used. When torque is expected as in rotational osteotomies, the K-wire holes in guides should be oriented transversely to reduce intraoperative deformation.

Accuracy of Combined High Tibial Slope Correction Osteotomy Using 3-Dimensional-Planned Patient-Specific Instrumentation.

If an increased posterior tibial slope (PTS) and concomitant unicompartmental osteoarthritis are present, a simultaneous sagittal (slope) and coronal correcting high tibial osteotomy has been recommended. However, no study has investigated the accuracy of such combined high tibial slope correction osteotomies. (1) To report the accuracy of navigated high tibial slope correction osteotomies using patient-specific instruments (PSI) and (2) to analyze the influence of an open wedge osteotomy (OWO) versus a closed wedge osteotomy (CWO) and the hinge axis angle (HAA) on the accuracy of the PTS correction. Cohort study; Level of evidence, 3. All PSI PTS-reducing osteotomies performed at 1 institution between 2019 and 2022 were reviewed. Three-dimensional (3D) accuracy was defined as the mean absolute 3D angular difference between the planned and achieved surgical correction (in degrees) in 3D models of computed tomography data. The influence of OWO versus CWO and the HAA on the reported accuracy was analyzed and a cutoff defined using receiver operating characteristic curve analysis. Eighteen patients who underwent a slope-reducing CWO (n = 9) or OWO (n = 9) were included. The 3D accuracy for PTS was 2.3°± 1.1° (mean ± SD), with CWO being more accurate than OWO (1.4°± 0.9° vs 3.1°± 0.6°; P < .01). Accuracy strongly correlated with the HAA (r = 0.788; P < .01). An HAA >38.9° predicted a PTS error >2° (odds ratio, 1.12 [95% CI, 1.04-1.20; P = .004]; area under the curve, 0.95 [95% CI, 0.89-1.00; P < .001]) corresponding to a coronal/sagittal correction of 0.8:1. Slope-reducing osteotomy can accurately be achieved using PSI. CWO demonstrated an increased accuracy when compared with OWO, which strongly depended on the HAA. With an aim of combined PTS and coronal correction, CWO should be considered the primary choice for accurate slope reduction with a coronal/sagittal correction cutoff of 0.8:1 (HAA, 38.9°).

Reconstruction of radial deviation after preaxial polydactyly surgery: use of an ulnar fascial flap.

Radial deviation of the interphalangeal (IP) joint is a common complication of treating Wassel type IV-D preaxial polydactyly. Long-term radial deviation can place excessive tension on the radial skin and cause overabundance of the ulnar skin. To overcome this problem, we aimed to utilize a fascial flap for ulnar reconstruction of a defect in the radial skin. We used a fascial flap for ulnar reconstruction of a defect in the radial skin, eight patients (average: 12 years, range: 5-33 years) who underwent reconstructive surgery at our department for radial deviation of the interphalangeal (IP) joint after the initial operation were included between August 2017 and August 2021. An incision was made on the radial side of the thumb. An olive-shaped flap was designed on the ulnar eminence of the IP joint. The skin and fascia in the other three quadrants were incised. While the flap was protected, children with epiphyseal plates underwent wedge osteotomy at the maximum ulnar deviation of the proximal phalanx, and adults underwent direct fusion of the distal IP joint. Absorbable sutures were used to suture the flap. The Tada functional and visual analog scale (VAS) scores were recorded before and after the operation. All flaps survived without infection or necrosis. The preoperative and postoperative Tada scores were 1 and 5, respectively, and the preoperative and postoperative VAS scores were 3 and 9, respectively. The postoperative scores showed a statistically significant degree of improvement. An ulnar fascial flap is an effective and feasible option for repair of radial deviation following surgery for preaxial polydactyly.

Removal of the navicular bone with wedge osteotomy of the cuboid bone as a method of surgical treatment of cavus foot. Clinical case

Removal of the navicular bone with wedge osteotomy of the cuboid bone as a method of surgical treatment of cavus foot. Clinical case

Quantitative analysis of protective Kirschner wire diameters in lateral opening wedge distal femoral osteotomy: A finite element study.

This study aims to investigate quantitatively the protective effect of a 1.6-mm or a 2.5-mm Kirschner wire (K-wire) on the medial hinge at different gap distances through finite element analysis (FEA) and to establish whether using a 2.5-mm K-wire can offer benefits compared to a 1.6-mm in preventing medial hinge fractures. Between June 2024 and July 2024, three different models simulating a lateral opening wedge (LOW) osteotomy of the distal femur were created from a femoral computed tomography (CT) scan of a 36-year-old male patient: no K-wire (Model I), 1.6-mm K-wire (Model II), and 2.5-mm K-wire (Model III). Finite element analysis was performed to simulate 7- to 13-mm gaps at the osteotomy site. Loads, principal stress, strain, and equivalent stress were analyzed around the medial hinge. Model I required 123.0±5.2 N, Model II required 181.7±12.2 N, and Model III required 228.7±13.6 N (p<0.001). Cracked shell elements were the lowest in Model II and the highest in Model I. While the average equivalent/yield stress ratio was not significantly lower in Model II compared to Model III (87.0±10.9% vs. 92.7±12.1%), the maximum equivalent/yield stress ratio values in Model II were significantly lower than both Model I and Model III (1206.2±138.3% vs. 1836.2±165.4% and 1689.1±404.0%, respectively), suggesting a superior dispersion of forces. Using a 1.6-mm K-wire during LOW osteotomy of the distal femur provides a balance between structural reinforcement and stress distribution, significantly improving stability and reducing the risk of medial hinge fractures compared to a 2.5-mm K-wire or no K-wire. The 1.6-mm K-wire optimizes stress dispersion, making it the preferred choice for surgical planning in lateral opening wedge distal femoral osteotomy.

Correction of Triphalangeal Thumb with Small Delta Phalanx by Closed Wedge Osteotomy of the Proximal Phalanx: A Case Report

Background: Triphalangeal thumb (TPT) is a rare congenital anomaly, especially in the Asian population. Traditional treatments depend on the type of deformity and the presence of concomitant anomalies and include either excision in addition to the ligament reconstruction or fusion and shortening osteotomy. Instability and stiffness are the major concerns following the traditional techniques. Case Report: In this study, we report a case of right TPT with a small delta phalanx in a nine-year-old boy who was treated by proximal phalanx radial closed wedge osteotomy without delta phalanx resection or intracapsular dissection. The angular deformity and the appearance of the thumb were corrected by this simple procedure without resulting in instability and stiffness in the interphalangeal joint. Conclusion: Proximal phalanx closed wedge osteotomy is a rapid, simple, and effective technique with a low risk of unexpected complications for correcting the appearance in the cases of TPT with a small delta phalanx.

Cone-beam CT volumetry: a new method for evaluating osteotomy healing - a clinical evaluation and MDCT comparison.

Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42-2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73-1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy.

Biomechanical Changes to the Hindfoot After Zadek Osteotomy.

Insertional Achilles tendinopathy (IAT) is a common source of heel pain in active adults and athletes. The Zadek osteotomy (ZO) is a calcaneal dorsal closing wedge osteotomy that has demonstrated clinical success as a treatment for IAT, purported to favorably improve tendon mechanics, decrease impingement, and decrease pressure within the retrocalcaneal bursa. The present study aims to evaluate the biomechanical effects of ZO on Achilles strain, position of the Haglund prominence relative to the Achilles insertion, and retrocalcaneal pressure. The ZO was performed on 10 fresh-frozen foot and ankle mid tibia-fibula cadaveric specimens. An osteotomy was performed using a 1-cm dorsal closing wedge procedure secured with a 7.0 mm cannulated screw. Point pressure sensor catheters and differential variable reluctance transducers were used to measure the retrocalcaneal pressure and Achilles strain, respectively, pre- and postosteotomy. Paired t-tests were utilized to detect statistical differences (P < .05). After the ZO, the Haglund prominence was translated 9.9 mm anteriorly with respect to the insertion of the Achilles (P < .05) and the Achilles tendon insertion was translated 3.4 mm proximally (P < .05). The ratio of calcaneal length to greater tuberosity length, the X/Y ratio, increased from 2.56 to 3.52 with the osteotomy (P < .05). At maximum dorsiflexion, retrocalcaneal pressure decreased from 117 to 66 mm Hg (44%, P = .018). The Achilles strain changed from 0.00362 to 0.00436 in the anterior fibers (P = .484) and changed from 0.00467 to 0.00283 in the posterior fibers (P = .088). Biomechanical testing in a cadaveric model demonstrates that the ZO decreased retrocalcaneal pressure, shifted the Achilles tendon insertion proximally, increased the X/Y ratio of the calcaneus, and did not significantly change the strain of the Achilles tendon. Despite the clinical success demonstrated in recent literature, there are no biomechanical studies describing the effect of the ZO on the biomechanics of the hindfoot, and the mechanism of symptom relief of the ZO for IAT is not well understood. The present study measures two potential ZO effects relative to Haglund prominence by measuring retrocalcaneal pressure and displacement of the Achilles tendon with respect to the Haglund prominence, and measures one ZO effect relative to calcification of the tendon by measuring the Achilles tendon strain.

Comparative study of dorsiflexion closing wedge osteotomy of the metatarsal head and osteochondral autologous transplantation for Freiberg disease treatment: A multicenter analysis

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society–lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score.Level of Evidence: Level 3

Clinical and Radiographic Outcomes in Kienbock Disease Following Radial Closing Wedge Osteotomy: An Age Comparative Study and Literature Review.

Age is a preoperative prognostic factor for radial closing wedge osteotomy (RCWO) in Kienbock disease. Specifically, for cases classified as Lichtman stage III, clear criteria for selecting RCWO have not been established. We believe that age can provide vital information for determining the appropriate surgical procedure for Kienbock disease. The aim of this study was to investigate RCWO outcomes for Lichtman stage III by examining different age groups from clinical and radiological perspectives. Sixteen patients with Lichtman stage III Kienbock disease underwent RCWO. The median age was 59 years, and the median follow-up period was 2.9 years. We determined the age cutoffs for clinical and radiological outcomes using a receiver operating characteristic curve. Subsequently, we conducted intergroup comparisons of postoperative outcomes between the younger and older age groups. Age cutoffs were established at 52.5 and 30 years for clinical and radiological outcomes, respectively. In the comparative analysis, the younger age group (≤52 years; n = 7) demonstrated significantly superior clinical results, including improved range of motion and pain relief, higher postoperative Mayo Wrist Score, and lower Disability of the Arm, Shoulder, and Hand scores. From a radiological perspective, the younger age group (≤30 years; n = 3) experienced segmented lunate bone fragments healing, indicating an improved disease stage compared with the older group. Based on previous literature and our research findings, it is reasonable to conclude that RCWO results in improved clinical outcomes for patients up to their mid-50s and enhanced radiological outcomes for those up to approximately at the age of 30 years. Further studies on these age cutoffs will contribute to refining the surgical selection criteria for RCWO. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.