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Radial Osteotomy for Kienböck Disease

Nakamura, Ryogo MD*; Nakao, Etsuhiro MD*; Nishizuka, Takanobu MD*; Takahashi, Sayako MD*; Koh, Shukuki MD

Techniques in Hand & Upper Extremity Surgery: March 2011 - Volume 15 - Issue 1 - p 48–54
doi: 10.1097/BTH.0b013e31820baa36
Kienböck's Disease: The Past 100 Years and a Look at the Future, Edited by Dr. Gregory I. Bain: Techniques
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Of various surgical treatments, radial shortening for patients with negative ulnar variance and radial wedge osteotomy (radial closing osteotomy) for patients with 0 or positive ulnar variance are widely accepted for the treatment of Kienböck disease. Long-term follow-up studies have shown more than 10 years lasting satisfactory pain relief, as well as an increase in wrist range of motion and grip strength. As representative surgical procedures, the techniques of radial shortening by transverse osteotomy, using a locking compression plate for internal fixation, and radial wedge osteotomy by step-cut osteotomy, using a small dynamic compression plate or locking compression plate, are described. One important point of radial wedge osteotomy is that resection of simple wedge bone yields a decrease in ulnar variance; therefore, we recommend trapezoidal bone resection with ulnar height of 1 mm for transverse osteotomy at the metaphysis and ulnar height of 2 mm for step-cut osteotomy at the distal fourth of the radius.

*Nagoya Hand Center, Department of Orthopedic Surgery, Chunichi Hospital

Department of Orthopedic Surgery, Nagoya First Red Cross Hospital, Nagoya, Japan

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this study.

Address correspondence and reprints requests to Ryogo Nakamura, MD, Nagoya Hand Center, Chunichi Hospital, 3-12-3 Marunouchi Nakaku, Nagoya 460-0002, Japan. e-mail: h_geka@chunichi-hp.jp.

© 2011 Lippincott Williams & Wilkins, Inc.