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Radial Shortening Osteotomy in Advanced Stages of Kienbock Disease

Mozaffarian, Kamran MD; Namazi, Hamid MD; Namdari, Asghar MD

Techniques in Hand & Upper Extremity Surgery: December 2012 - Volume 16 - Issue 4 - p 242–246
doi: 10.1097/BTH.0b013e31826d2f77
Techniques

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.

Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Kamran Mozaffarian, MD, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran 7194815644 (e-mail: kammoza@gmail.com).

© 2012 Lippincott Williams & Wilkins, Inc.