Radial Osteotomy for Kienböck Disease: Clinical and Radiological Comparison between Younger and Older Patients

Background: The usefulness of radial osteotomy for older patients remains unclear. The purpose of this study was to compare the clinical and radiological outcomes of radial osteotomy with volar locking plate between younger and older patients with Kienböck disease stages II to IIIB. Methods: This was a retrospective comparative study of 21 consecutive patients treated at our department. Lichtman's classification was used for staging, and four patients had stage II, six patients had stage IIIA, and 11 patients had stage IIIB disease. We divided them into two groups to compare the radiological and clinical results between younger (younger than 40 years) and older patients. The mean follow-up periods in the younger and older groups were 4 and 3.6 years, respectively. For radiological assessment, we evaluated the carpal height ratio (CHR), Stahl index, and union of the fractured lunate. For clinical assessment, we examined the range of motion of the wrist, grip strength, numeric rating scale (NRS) for pain, and the patient-reported Hand20 score preoperatively and at the final follow-up. Results: There were 12 patients in the younger group with a mean age of 23 years (range, 12-37 years), and 9 in the older group with a mean age of 56 years (range, 40-74 years). There were no intra- and post-operative complications in either group. Radiological improvement, including CHR, Stahl index, and union of the fractured lunate, was more common in the younger group than in the older one, as was the case for clinical improvement. However, even in the older group, significant clinical improvement, including the range of motion of the wrist, NRS for pain, and the Hand20 score, was seen postoperatively. Conclusions: Radial osteotomy appears to be a safe and reliable option in older symptomatic patients with Kienböck disease stages II to IIIB.

Lunate loads following different osteotomies used to treat Kienböck's disease: A 3D finite element analysis

BACKGROUND

One of most accepted principles for treating Kienböck's disease before wrist degeneration settles in is to decompress the lunate by an osteotomy. Several osteotomies have been proposed since 1935. However, they are based on biomechanical hypotheses that are sometimes conflicting: This study compares the decompression effect of radius transverse shortening, radius lateral closing and medial closing wedge osteotomies, capitate shortening - with and without hamate shortening - and a Camembert-type radius wedge osteotomy with and without ulnar head shortening according to Sennwald.

METHODS

We built a 3D wrist model using finite elements that included the metacarpal, carpal and forearm bones. All wrist ligaments and Triangular Fibrocartilage Complex were incorporated in the simulation. Load was applied on the metacarpals with the forearm bones fixed. We then applied the different osteotomies to the model.

FINDINGS

When load was applied to the wrist, the osteotomies that best unloaded the lunate were the capitate shortening osteotomy combined with hamate shortening and the Camembert osteotomy combined with ulna shortening; the latter was the only osteotomy that completely unloaded the lunate.

INTERPRETATION

We think the association of the radius Camembert osteotomy and ulna Sennwald's shortening osteotomy is the most effective procedure to propose in Kienböck's disease.

Radial osteotomy for the correction of forearm deformities in hereditary multiple osteochondroma

Forearm deformities are often observed in patients with hereditary multiple osteochondroma, resulting in functional disability and cosmetic impairment. The aim of this study was to assess clinical and radiological outcomes after corrective osteotomy of the radius (COR). We performed a retrospective analysis of clinical and radiologic data from patients with forearm deformities who underwent COR combined with osteochondroma resection between 1978 and 2015. Seventeen patients (17 forearms) were included. The mean (range) age at surgery was 11.8 years (3.2-14.4), and the mean interval between surgery and last follow-up was 8.2 years (2-34.2). Range of motion was moderately increased and postoperative radiological assessments found significant improvements in ulnar variance, radial articular angle, bowing of the radius, and carpal slip. At last follow-up, a loss of ulnar variance correction was noted in 11 cases (mean loss: 4mm). The mean score on the Quick Disabilities of the Arm, Shoulder and Hand self-administered questionnaire was 13.9. Our results show that a forearm deformity in a patient with hereditary multiple osteochondroma is an appropriate indication for COR combined with osteochondroma resection and should be performed at the end of growth. This simple, safe technique corrects bowing of the radius and radius-ulna length discrepancy and could limit the risk of radial head dislocation. LEVEL OF EVIDENCE: IV.