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Operative Technique of a New Decompression Procedure for Kienböck Disease: Partial Capitate Shortening

Moritomo, Hisao MD; Murase, Tsuyoshi MD; Yoshikawa, Hideki MD

Techniques in Hand & Upper Extremity Surgery: June 2004 - Volume 8 - Issue 2 - p 110-115
doi: 10.1097/01.bth.0000126571.20944.47
TECHNIQUE
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A new decompression procedure for Kienböck disease, namely “partial capitate shortening,” was developed. Patients in Lichtman stages 2 and 3A, independent of the ulnar variance, are candidates for this procedure. This procedure can dramatically reduce compressive forces on the lunate almost as much as a traditional decompression procedure of the capitate (capitate shortening combined with capitate-hamate fusion) and much more than the decompression procedure of the forearm bone such as radial shortening. We surmise that our procedure will allow better lunate revascularization. Although the scaphoid progressively adopts an abnormal palmarflexed position after capitate shortening combined with capitate-hamate fusion, partial capitate shortening can maintain normal carpal alignment, resulting in better joint congruency around the scaphoid and range of motion of the wrist. Moreover, partial capitate shortening allows minimal invasion and is an easy technique without bone grafting. Both operating and immobilizing time are shortened, and there are no secondary problems in the distal radioulnar and/or ulnocarpal joint often seen after radial osteotomy procedures.

Department of Orthopaedic Surgery

Osaka University Medical School

Osaka, Japan

Address correspondence and reprint requests to Hisao Moritomo, MD, Department of Orthopaedic Surgery, Osaka University Medical School, 2-2, Yamadaoka, Suita-shi, Osaka, 565-0871 Japan. E-mail: moritomo@ort.med.osaka-u.ac.jp.

© 2004 Lippincott Williams & Wilkins, Inc.