[STT-arthrodesis versus radial shortening osteotomy for Kienböck's disease]

Thirteen patients treated by STT fusion for Kienböck's disease (five stage 3 a, seven stage 3 b, and one stage 4) and 36 patients treated by radial shortening osteotomy (20 stage 3 a, 16 stage 3 b) were checked after 26 and 83 months average. The active range of motion and grip strength were compared by means of the Cooney score, discomfort and pain by the DASH score. X-rays were compared for the bone structure of the lunate and development or progress of carpal collapse. After STT fusion the active over-all range of motion decreased by about 10 degrees, grip strength improved slightly by approximately 10 %, pain and discomfort improved well. Consolidation of the lunate was seen in ten of thirteen patients. The patients treated with radial shortening osteotomy could all improve their range of motion by about 10 degrees and the grip strength by about 20 %, whereas discomfort and pain persisted in some cases. X-rays showed consolidation of the lunate in cases of eleven patients stage 3 a and twelve patients stage 3 b. Radiological results were not always corresponding to the clinical results and the patients' subjective estimation. A group of eight patients could be followed up after more than ten years; all of them showed excellent results. This may indicate the long-term result for those patients who benefit from radius shortening with early pain relief. We recommend both procedures for stage 3 a and 3 b and suggest to decide from case to case, according to the needs of the patient. Ulna minus variance or the patient's wish to restore full active range of motion indicate radial shortening.