Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion–extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock’s disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.

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Five cases of painful diaphyseal pseudarthrosis of the distal phalanx were treated with a longitudinal compression AO mini screw, without bone graft, and all healed uneventfully in 3 to 4 months.

Seventeen cases of instability of the trapeziometacarpal joint were treated surgically using either the original Brunelli technique or one of two modifications. Six patients achieved very good, nine achieved good and two achieved poor results. The results of the three surgical techniques were similar and we recommend the use of the palmaris longus tendon for the ligament reconstruction, as it is the easiest to perform.

Objectivos. Rever os resultados das osteotomias de encurtamento do rádio efectuadas nos doentes com doença de Kienbock avançada (estadio IIIB).Material e métodos. Nos últimos 24 anos operámos 50 casos de doença de Kienbock com osteotomia de encurtamento do rádio. 16 tinham já colapso cárpico (Lichtman IIIB). Os seus processos clínicos e radiografias foram revistos.Resultados. Os bons resultados clínico obtidos em doentes só com colapso do semi-lunar (Lichtman IIIA) confirmam os da literatura, mas obtivemos resultados igualmente bons em casos já com colapso cárpico (Lichtman IIIB), que apresentamos.Conclusões. Os resultados aqui apresentados poderiam alargar as clássicas indicações da osteotomia de encurtamento do rádio no tratamento da doença de Kienbock