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J Wrist Surg
DOI: 10.1055/a-2784-4185
Scientific Article

Optimizing Wedge Osteotomy for Load Reduction on Lunate Bone in Kienböck's Disease: Findings and Recommendations of a Biomechanical Study

Authors

  • Hamid Namazi

    1   Orthopedic and Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

  • Arsalan Ostovari

    1   Orthopedic and Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

  • Mahsa Rahnama

    1   Orthopedic and Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

  • Mohammad T. Karimi 

    1   Orthopedic and Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
    2   Orthotics and Prosthetics Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract

Background

Conflicting results in biomechanical studies on radial osteotomies highlight the value of simulation studies in understanding the mechanisms and factors affecting the success of radial wedge osteotomy. This biomechanical study aimed to determine the efficacy of various radial wedge osteotomies in subjects with Kienbock's disease based on three-dimensional (3D) modeling.

Methods

Computed tomography scan images of a normal wrist joint were used to generate a 3D model of the wrist joint. Various simulated radial open wedge osteotomies, including medial and lateral procedures, different osteotomy lengths, and osteotomy angles, were evaluated. The stress exerted on the lunate bone in the radio-lunate and lunate-capitate joints was determined under each of these conditions.

Results

The location of the radial wedge osteotomy significantly influenced the loads applied to the lunate bone during wrist motion, with the preferred method being 1 inch proximal to the wrist joint axis. The degree of wedge osteotomy also had an impact, with a 10-degree wedge osteotomy being preferred. Additionally, the site of osteotomy appeared to be important, with lateral opening being superior to lateral closing.

Conclusion

Wedge osteotomy is recommended as a preferred method for reducing stress on the lunate bone. It is recommended to perform the osteotomy 1 inch proximal to the wrist joint with a 10-degree angle and utilizing a lateral opening technique.

Level of Evidence

V.

Keywords

Kienböck's disease - radial osteotomy - radial open wedge osteotomy - finite element analysis - 3D modeling

Data Availability Statement

Data will be shared on request to the corresponding author.


Contributors' Statement

M.T.K. and H.N. were responsible for supervision. The modeling was done by M.T.K. M.R. and A.O. was responsible to prepare the draft of the paper. All authors edit and check the final draft of the article.




Publication History

Received: 25 August 2025

Accepted: 07 January 2026

Article published online:
10 February 2026

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