RADIAL OSTEOTOMY IN THE TREATMENT OF KIENBOCK DISEASE

Abstract

Introduction: Long-term results of radial osteotomy for Kienbock’s disease seldom are seen in the literature. The purpose of this study was to evaluate its outcome.

Material: Fifteen patients submitted to radial osteotomy were followed by a mean period of 9,5 years. Mean age at the time of surgery was 32,1 years. On the basis of the Lichtman classification, one patient had Stage II, eight had Stage IIIA and six had Stage IIIB disease.

Methods: Patients were evaluated clinically for pain, grip and range of motion (ROM); radiologically, according to carpal height ratio, Stahl’s index (lunate colapse), and for sclerotic, cystic and degenerative carpal changes. These data were classified according to the Nakamura Scoring System for Kienbock (NSSK).

Results: Ten patients are asymptomatic and five have mild pain. ROM improved significantly by 20,8°. When compared with the contralateral wrist, mean range of motion was 78% in flexion and 76% in extension and mean grip strength was 82,3%. Carpal height ratio and Stahl’s index improved, as shown by a mean NSSK of 24,3 (ten Excellent and five Good results). There was no progression to wrist arthritis.

Discussion: Pain, ROM and grip strength improved significantly after surgery. Despite the mild radiologic changes, there seems to have been an improvement in inner structure of the ischemic lunate.

Conclusions: These results show that Radial Osteotomy is an effective procedure in improving clinical and functional scores, and in preventing wrist arthritis.