Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease

Rodrigues-Pinto, Ricardo; Freitas, Davide; Costa, Lucia Cortes da; Sousa, Ricardo; Trigueiros, Miguel; Lemos, Rui; Silva, C.; Oliveira, A.

doi:10.1302/0301-620x.94b2.27729

Cited by 18 publications

(19 citation statements)

References 41 publications

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“…Studies with more than 10 years of follow-up on average report mean (Quick)DASH scores between 6.1 and 14 and pain scores between 0.2 and 3.0 after radial shortening osteotomy (►Table 4). [21][22][23][24][25] Luegmair et al found that patients had poorer physical function when the dominant side was affected. 25 We found no such difference by hand dominance.…”

Section: Discussionmentioning

confidence: 99%

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

et al. 2020

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Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck's disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments. Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck's disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction. Results We included 48 patients who had radial shortening osteotomy alone, and 17 patients who had a combined procedure of radial shortening and direct revascularization. The rate of unplanned reoperations was 33% (16 of 48) in those who had radial shortening osteotomy and 24% (4 of 17) in those who had a combined procedure. Six (13%) of 48 patients underwent proximal row carpectomy due to failed radial shortening osteotomy. No salvage procedures were performed after combined radial shortening/revascularization. Median PROMIS Physical Function CAT scores were 56 (interquartile range [IQR]: 44–56) and 56 (IQR: 41–56), respectively. Median PROMIS Pain Interference scores were 39 (IQR: 39–52) and 39 (IQR: 39–49), respectively. Median QuickDASH scores were 2.3 (IQR: 0–23) and 4.5 (IQR: 2.3–14), respectively. Conclusion Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function. We observed that approximately one in eight patients underwent salvage surgery after radial shortening, and this should be taken into account when making the initial decision to treat Kienböck's disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term. Level of Evidence This is a Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

et al. 2020

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“…The only documented difference between radial shortening and ulnar lengthening is that the latter is associated with higher rates of nonunion. 2 To avoid the complications and technical pitfalls of radial shortening osteotomy in addition to inappropriateness for patients with positive ulnar variance, Almquist 3 in 1986 described an alternative procedure to reduce lunate pressure: a capitate-shortening osteotomy associated with capitate-hamate fusion (CSCHF).…”

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confidence: 99%

Partial Capitate with/without Hamate Osteotomy in the Treatment of Kienböck's Disease: Influence of the Stage of the Disease on the Midterm Outcome

et al. 2020

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Objective Moritomo et al introduced partial capitate osteotomy as a treatment modality for early stages of Kienböck's disease. This technique maintains articular contact between the capitate and the scaphoid. We added hamate-shortening osteotomy in addition to partial capitate shortening in cases of lunate type II. The purpose of this study was to evaluate intermediate-term results of partial capitate shortening, investigate the influence of the stage of the disease on the outcome, and assess the clinical and radiological outcomes of adding hamate osteotomy in cases of type II lunate. Patients and Methods A total of 17 consecutive patients (3 women, 14 men) with early stages of Kienböck's disease were prospectively reviewed using the aforementioned technique. Eight patients were in stage II and nine patients were in stage IIIA according to the Lichtman classification system. Clinical outcome measures included pain visual analog score, grip strength and range of motion as a percentage of the unaffected side, and assessment using the Patient-Rated Hand and Wrist Evaluation (PRHWE) and the modified Wrightington Hospital Wrist Score (MWHWS). Radiological outcome measures included healing of the osteotomy site, Stahl index, radioscaphoid angle, and progression of the disease. Results Follow-up period averaged 72 months. All cases of isolated capitate osteotomy and combined capitate and hamate osteotomies united fully. Clinical results revealed significant improvement in pain, grip strength and extension, and PRHWE and MWHWS values. Wrist flexion did not change postoperatively. Patients with stage II showed better overall results and significant MWHWS improvement. Conclusion At the intermediate term, partial capitate with/without hamate shortening is an effective modality for the treatment of patients with early stage Kienböck's disease. Stage II patients showed better results than stage IIIA patients in terms of pain, flexion, grip, PRHWE, and MWHWS. Adding hamate osteotomy may improve the functional results for type II lunate; however, a larger sample is needed to elicit statistical significance. Level of Evidence This is a Level IV, therapeutic study.

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“…2 This became a dogma for most hand surgeons 15 despite the good clinical results published by many authors with radial osteotomies in advanced Kienbock's disease. [16][17][18][19][20][21][22][23]…”

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confidence: 99%

Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

2019

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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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Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease

Cited by 18 publications

References 41 publications

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

Partial Capitate with/without Hamate Osteotomy in the Treatment of Kienböck's Disease: Influence of the Stage of the Disease on the Midterm Outcome

Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

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