Download PDF
J Wrist Surg 2019; 08(04): 264-267
DOI: 10.1055/s-0039-1688947
Special Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

J. C. Botelheiro
1   Department of Orthopaedics, Hospital dos Lusiadas, Lisbon, Portugal
,
Silvia Silverio
2   Department of Orthopaedics, Hospital de Sant’Ana, Parede, Portugal
,
Ana Luísa Neto
2   Department of Orthopaedics, Hospital de Sant’Ana, Parede, Portugal
› Author Affiliations
Further Information

Publication History

26 February 2019

09 April 2019

Publication Date:
28 May 2019 (online)

   Permissions and Reprints

Abstract

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.

Keywords

Kienbock's disease - carpal collapse - radial osteotomy
 

  • References

  • 1 Axelson R, Moberg E. Le traitement de la maladie de Kienbock et le role des interventions de reequilibration radio-cubitale. In: Razemon JP, Fisk GR. , eds. Le poignet: Monographies du G.E.M. Paris: Expansion Scientifique Francaise; 1983: 210-217
    Google Scholar
  • 2 Alexander AH, Lichtman DM. The Kienbock dilemma - how to cope. In: Nakamura R, Lischeid RL, Miura T. , eds. Wrist Disorders - Current Concepts and Challenges. Tokyo: Springer-Verlag; 1992: 79-88
    Google Scholar
  • 3 Lamas C. La enfermedad de Kienbock. Barcelona J.M.. Bosch Editor 2005; 100–2: 123-135
    PubMedGoogle Scholar
  • 4 Bain GI, Begg M. Arthroscopic assessment and classification of Kienbock's disease. Tech Hand Up Extrem Surg 2006; 10 (01) 8-13
    CrossrefPubMedGoogle Scholar
  • 5 Lichtman DM, Pientka II WF, Bain GI. Kienböck disease: a new algorithm for the 21st century. J Wrist Surg 2017; 6 (01) 2-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Mikkelsen SS, Gelineck J. Poor function after nonoperative treatment of Kienböck's disease. Acta Orthop Scand 1987; 58 (03) 241-243
    CrossrefPubMedGoogle Scholar
  • 7 Salmon J, Stanley JK, Trail IA. Kienböck's disease: conservative management versus radial shortening. J Bone Joint Surg Br 2000; 82 (06) 820-823
    CrossrefPubMedGoogle Scholar
  • 8 D'Hoore K, De Smet L, Verellen K, Vral J, Fabry G. Negative ulnar variance is not a risk factor for Kienböck's disease. J Hand Surg Am 1994; 19 (02) 229-231
    PubMedGoogle Scholar
  • 9 van Leeuwen WF, Oflazoglu K, Menendez ME, Ring D. Negative ulnar variance and Kienböck disease. J Hand Surg Am 2016; 41 (02) 214-218
    CrossrefPubMedGoogle Scholar
  • 10 Trumble T, Glisson RR, Seaber AV, Urbaniak JR. A biomechanical comparison of the methods for treating Kienböck's disease. J Hand Surg Am 1986; 11 (01) 88-93
    PubMedGoogle Scholar
  • 11 Horii E, Garcia-Elias M, Bishop AT, Cooney WP, Linscheid RL, Chao EY. Effect on force transmission across the carpus in procedures used to treat Kienböck's disease. J Hand Surg Am 1990; 15 (03) 393-400
    PubMedGoogle Scholar
  • 12 Trail IA, Linscheid RL, Quenzer DE, Scherer PA. Ulnar lengthening and radial recession procedures for Kienböck's disease. Long-term clinical and radiographic follow-up. J Hand Surg [Br] 1996; 21 (02) 169-176
    PubMedGoogle Scholar
  • 13 Quenzer DE, Dobyns JH, Linscheid RL, Trail IA, Vidal MA. Radial recession osteotomy for Kienböck's disease. J Hand Surg Am 1997; 22 (03) 386-395
    PubMedGoogle Scholar
  • 14 Mathoulin C, Wahegaonkar AL. Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease. Microsurgery 2009; 29 (05) 373-378
    CrossrefPubMedGoogle Scholar
  • 15 Danoff JR, Cuellar DO, , O J, Strauch RJ. The management of Kienböck Disease: a survey of the ASSH membership. J Wrist Surg 2015; 4 (01) 43-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Gomis R, Martin B. Idoux, Chamas M et Allieu Y: Maladie de Kienbock - traitement par osteotomie de racourcissement du radius. Rev Chir Orthop Repar Appar Mot 1994; 80: 196-204
    PubMedGoogle Scholar
  • 17 Botelheiro JC. Treatment of Kienbock's disease by shortening osteotomy of the radius. Review of 20 cases. J Hand Surg Am 1997; 22B (Suppl. 01) 48
    PubMedGoogle Scholar
  • 18 Iwasaki N, Minami A, Oizumi N, Suenaga N, Kato H, Minami M. Radial osteotomy for late-stage Kienböck's disease. Wedge osteotomy versus radial shortening. J Bone Joint Surg Br 2002; 84 (05) 673-677
    CrossrefPubMedGoogle Scholar
  • 19 Altay T, Kaya A, Karapinar L, Ozturk H, Kayali C. Is radial shortening useful for Litchman stage 3B Kienbock's disease?. Int Orthop 2008; 32 (06) 747-752
    CrossrefPubMedGoogle Scholar
  • 20 Calfee RP, Van Steyn MO, Gyuricza C, Adams A, Weiland AJ, Gelberman RH. Joint leveling for advanced Kienböck's disease. J Hand Surg Am 2010; 35 (12) 1947-1954
    CrossrefPubMedGoogle Scholar
  • 21 Rodrigues-Pinto R, Freitas D, Costa LD. , et al. Clinical and radiological results following radial osteotomy in patients with Kienböck's disease: four- to 18-year follow-up. J Bone Joint Surg Br 2012; 94 (02) 222-226
    CrossrefPubMedGoogle Scholar
  • 22 Mozaffarian K, Namazi H, Namdari A. Radial shortening osteotomy in advanced stages of Kienbock disease. Tech Hand Up Extrem Surg 2012; 16 (04) 242-246
    CrossrefPubMedGoogle Scholar
  • 23 Shin YH, Kim J, Gong HS, Rhee SH, Cho MJ, Baek GH. Clinical outcome of lateral wedge osteotomy of the radius in advanced stages of Kienböck's disease. Clin Orthop Surg 2017; 9 (03) 355-362
    CrossrefPubMedGoogle Scholar
  • 24 Rooker GD, Goodfellow JW. Maladie de Kienbock chez les infirmes moteurs. cérébraux. In: Le poignet. Paris: Expansion Cientifique Française; 1983
    Google Scholar
  • 25 Tatebe M, Hirata H, Iwata Y, Hattori T, Nakamura R. Limited wrist arthrodesis versus radial osteotomy for advanced Kienböck's disease--for a fragmented lunate. Hand Surg 2006; 11 (1-2): 9-14
    CrossrefPubMedGoogle Scholar
  • 26 Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol 2010; 35 (07) 549-554
    CrossrefPubMedGoogle Scholar
  • 27 Botelheiro JC, Guia EM. Plating the palmar surface of the distal radius in shortening osteotomies for Kienböck's disease and Barton's fracture. J Hand Surg [Br] 1996; 21 (06) 833
    CrossrefPubMedGoogle Scholar
  • 28 Nakamura R, Imaeda T, Miura T. Radial shortening for Kienböck's disease: factors affecting the operative result. J Hand Surg [Br] 1990; 15 (01) 40-45
    CrossrefPubMedGoogle Scholar
  • 29 Watanabe K, Nakamura R, Horii E, Miura T. Biomechanical analysis of radial wedge osteotomy for the treatment of Kienböck's disease. J Hand Surg Am 1993; 18 (04) 686-690
    CrossrefPubMedGoogle Scholar
  • 30 Phemister DB. Treatment of ununited fractures by onlay bone grafts without screw or tie fixation and without breaking down of the fibrous union. J Bone Joint Surg Am 1947; 29 (04) 946-960
    PubMedGoogle Scholar
  • 31 Stahl S, Lotter O, Santos Stahl A. , et al. 100 years after Kienböck's description: review of the etiology of Kienböck's disease from a historical perspective [in German]. Orthopade 2012; 41 (01) 66-72
    CrossrefPubMedGoogle Scholar
  • 32 Golay SK, Rust P, Ring D. The radiological prevalence of incidental Kienböck disease. Arch Bone Jt Surg 2016; 4 (03) 220-223
    PubMedGoogle Scholar
  • 33 van Leeuwen WF, Janssen SJ, ter Meulen DP, Ring D. What is the radiographic prevalence of incidental Kienböck disease?. Clin Orthop Relat Res 2016; 474 (03) 808-813
    CrossrefPubMedGoogle Scholar
  • 34 Taniguchi Y, Tamaki T, Honda T, Yoshida M. Rotatory subluxation of the scaphoid in Kienböck's disease is not a cause of scapholunate advanced collapse (SLAC) in the wrist. J Bone Joint Surg Br 2002; 84 (05) 684-687
    PubMedGoogle Scholar
  • 35 Dias JJ, Lunn P. Ten questions on Kienbock's disease of the lunate. J Hand Surg Eur Vol 2010; 35 (07) 538-543
    CrossrefPubMedGoogle Scholar
  • 36 Garcia-Elias M, Lluch AL. Wrist instabilities, misalignements and dislocations. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. , eds, Green's Operative Hand Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017: 464
    Google Scholar
  • 37 Voche P, Bour C, Merle M. Scapho-trapezio-trapezoid arthrodesis in the treatment of Kienböck's disease. A study of 16 cases. J Hand Surg Br 1992; 17 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 38 Das Gupta K, Tünnerhoff HG, Haussmann P. STT-arthrodesis versus radial shortening osteotomy for Kienböck's disease [in German]. Handchir Mikrochir Plast Chir 2003; 35 (05) 328-332
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Croog AS, Stern PJ. Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am 2008; 33 (07) 1122-1130
    CrossrefPubMedGoogle Scholar
  • 40 Mir X, Barrera-Ochoa S, Lluch A. , et al. New surgical approach to advanced Kienböck disease: lunate replacement with pedicled vascularized scaphoid graft and radioscaphoidal partial arthrodesis. Tech Hand Up Extrem Surg 2013; 17 (02) 72-79
    CrossrefPubMedGoogle Scholar
  • 41 Kakinoki R, Yamakawa T, Nakayama K, Morimoto Y, Nakamura T. Treatment of progressive necrosis of the lunate bone (Kienböck disease) after unsuccessful radial osteotomy. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (05) 267-271
    CrossrefPubMedGoogle Scholar