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Radial osteotomy for Kienböck disease.
Ryogo Nakamura1, Etsuhiro Nakao, Takanobu Nishizuka
1Nagoya Hand Center, Department of Orthopedic Surgery, Chunichi Hospital, Nagoya, Japan. h_geka@chunichi-hp.jp
Techniques in Hand & Upper Extremity Surgery
|March 2, 2011
Summary
Surgical treatments like radial shortening and radial wedge osteotomy effectively manage Kienböck disease, offering long-term pain relief and improved wrist function. These procedures address negative, zero, or positive ulnar variance for optimal patient outcomes.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Wrist Biomechanics
Background:
- Kienböck disease is a degenerative condition affecting the lunate bone in the wrist.
- Surgical intervention is often necessary to manage pain and restore function.
- Ulnar variance (the relative length of the ulna and radius) is a key factor in treatment selection.
Purpose of the Study:
- To describe and recommend surgical techniques for Kienböck disease based on ulnar variance.
- To detail the methods for radial shortening and radial wedge osteotomy.
- To provide specific guidelines for bone resection during radial wedge osteotomy.
Main Methods:
- Radial shortening via transverse osteotomy with locking compression plate fixation.
- Radial wedge osteotomy (radial closing osteotomy) via step-cut osteotomy with dynamic or locking compression plate fixation.
- Detailed description of trapezoidal bone resection for radial wedge osteotomy (1 mm for transverse, 2 mm for step-cut).
Main Results:
- Long-term follow-up (over 10 years) demonstrates satisfactory pain relief.
- Significant improvements in wrist range of motion and grip strength are achieved.
- Specific bone resection techniques optimize ulnar variance correction.
Conclusions:
- Radial shortening and radial wedge osteotomy are effective surgical treatments for Kienböck disease.
- The choice of procedure depends on the patient's ulnar variance.
- Precise bone resection during radial wedge osteotomy is crucial for successful outcomes.
