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Joint leveling for advanced Kienböck's disease.

Ryan P Calfee1, Marlo O Van Steyn, Cassie Gyuricza

  • 1Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO63110, USA. calfeer@wudosis.wustl.edu

The Journal of Hand Surgery
|October 26, 2010
PubMed
Summary

Radius-shortening osteotomy shows similar clinical outcomes for advanced (stage IIIB) and less advanced (stage II/IIIA) Kienböck's disease. Static carpal malalignment did not prevent successful radius shortening in stage IIIB wrists.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Wrist Arthroscopy

Background:

  • Kienböck's disease, a condition affecting the lunate bone in the wrist, has limited treatment options based on disease severity.
  • Joint leveling procedures are often restricted by the advancement of Kienböck's disease.

Purpose of the Study:

  • To compare clinical and radiographic outcomes of radius-shortening osteotomy in wrists with advanced (stage IIIB) versus less advanced (stage II/IIIA) Kienböck's disease.

Main Methods:

  • A retrospective study included 31 adult wrists (30 patients) treated with radius-shortening osteotomy.
  • Patients were categorized into stage IIIB (n=14) or stage II/IIIA (n=17) Kienböck's disease.
  • Evaluations included clinical outcomes (patient-based and objective measures) and radiographic assessments at a mean of 74 months post-surgery.

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Main Results:

  • Clinical outcomes, including Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score, and visual analog scale (VAS) pain and function scores, were similar between stage IIIB and II/IIIA groups.
  • Range of motion and grip strength showed minimal differences between the groups.
  • Radiographic measures like carpal height ratio and radioscaphoid angle were less favorable in the stage IIIB group.
  • Disease progression occurred in 7 wrists (1 stage IIIB, 6 stage II/IIIA), with the progressed stage IIIB wrist requiring arthrodesis.

Conclusions:

  • Radius-shortening osteotomy yields comparable clinical outcomes for both stage II/IIIA and IIIB Kienböck's disease.
  • Static carpal malalignment in stage IIIB Kienböck's disease does not appear to preclude successful outcomes with radius-shortening osteotomy.
  • Further investigation with a larger patient cohort is warranted to confirm these findings.