RADIAL OSTEOTOMY WITH NAKAMURA EFFECT IN KIENBÖCK’S DISEASE

Abstract

Introduction and purpose: Kienböck’s disease was described by R. Kienbock in 1910. From that date onwards, multiple surgical techniques for its treatment have been described. Amongst these techniques is the one we have used: a radial osteotomy with Nakamura effect; this is a radial osteotomy with a wedge-shaped base and minimum dorsal width with subsequent osteoclasia carried out distally to the distal radioulnar joint to prevent any alterations in joint congruence. The aim of this study is to assess the results of this technique and compare them with those described in the literature using other surgical techniques.

Materials and methods: We selected patients with Kien-böck’s disease stage II and IIIA that underwent surgery using the technique described and we subsequently assessed clinical and radiological parameters both pre and postoperatively.

Results: Of the 17 patients diagnosed with Kienböck’s disease in our department, only 11 were operated using the technique described above. In these patients it was possible to see that a greater number had their dominant arm affected, there was a greater percentage of ulnar plus variants, the radial inclination angle was higher and the main symptom was pain. At this time, having undergone surgery, the patients are stable both clinically and radiologically, with the exception of 1 case that required rescue surgery. Satisfactory union was seen in 100% of cases after osteotomy.

Conclusions: During the initial stages, surgical treatment is preferable, and osteotomies are the techniques most frequently used. Radial osteotomy with Nakamura effect is a technique with excellent results, comparable to those seen with other techniques applied used during the initial stage.