No abstract

Radial shortening osteotomy is a well-accepted treatment for Kienbock disease in stages I to IIIA. The usefulness of this procedure in more advanced stages of the disease is controversial. In this study, 27 cases of stage IIIB and IV of Kienbock disease underwent radial shortening osteotomy and were followed for a mean period of 54.9 months (9 to 117 mo). Twenty-four patients had stage IIIB and 3 patients had stage IV disease. Sixteen of the affected wrists were on the dominant side. All patients were evaluated clinically and radiologically at last follow-up. Modified Mayo Score was used for clinical evaluation. The measured radiologic parameters included carpal height ratio, Stahl index, and radioscaphoid angle. In stage IIIB, 41.6% of cases had good, 54.2 had fair, and 4.2 had poor result, whereas in stage IV all patients showed poor result. The mean range of flexion-extension was 84.4% of the unaffected side. Considering the percentage of preserved motion, this procedure seems to be a good alternative to partial fusion for stage IIIB when the patient is willing to preserve more degrees of motion. Although the number of patients with stage IV disease was limited in this study, poor result in all of them may show the uselessness of this procedure in stage IV.

Locking compression plates have a higher profile in comparison to DCP, requiring careful attention to soft tissue. Therefore, inadvisable locking compression plating with conventional incision method and retaining anatomical reduction of the fracture can lead to a higher soft tissue complication in comparison to dynamic compression plating.

Aneurysmal bone cyst (ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. Arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement.

Levothyroxin demonstrated efficacy in preventing heterotopic ossification.