Long-Term Follow-up of Radial Shortening Osteotomy for Kienbock Disease

Author(s): Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, and Ogino T

Source: J Bone Joint Surg 90-A (8): 1705-1711, 2008.

Summary:

Three previous studies have investigated the long-term results of radial osteotomy in the treatment of patients with Kienbock disease.  However, little is known about patient based long-term outcomes.  The current study investigates the long-term clinical and radiographic outcomes of this radial shortening osteotomy, including patients’ subjective evaluation with use of the DASH-JSSH (DASH translated into Japanese by the Japanese Society for Surgery of the Hand (JSSH) and is referred to as the DASH-JSSH).

Between 1977 and 1994, nineteen patients with Kienbock disease (stage II, IIIA, and IIIB) underwent radial shortening osteotomy.  Prior to 1981, osteotomies were as large as 5mm, however after 1981; all patients were treated with 2-3mm of radial shortening only.  A DASH questionnaire was filled out and returned by thirteen of the nineteen patients.  The ulnar variance was positive in six patients, neutral in four, and negative in three.  In three of the six patients with positive ulnar variance, an ulnar shortening osteotomy was performed in addition to the radial shortening. 

Improvement was reported by twelve of the thirteen patients with respect to pain.  Ten of the thirteen patients noted improvement with respect to range of motion, and eleven noted improvement with respect to strength.   On physical examination seven of the twelve patients had wrist pain when an axial force was applied to the extended wrist.  Progression of the disease was noted in six of the twelve patients.  The mean DASH score was 8 points (range, 0 to 23 points) and patient satisfaction was high.  DASH scores tended to be worse in patients with Stage-IIIB disease.

While this study suffers from a number of short comings such as small sample size, varied surgical procedures, and retrospective nature, a few things can be taken from this study that can aide in patient care.  First, radial shortening osteotomy has a fairly good long-term track record and may prevent progression of the disease to Lichtman stage IV. 

Additionally, wrist pain generally improves but may persist when loading the extended wrist. Patients commonly see improvements in grip strength and range of motion postoperatively.  Finally, if confronted with a patient with positive ulnar variance, one could consider adding an ulnar shortening osteotomy to the radial shortening instead of defaulting to another procedure.  However, this study does not specifically evaluate this issue, and thus shortening both bones is not supported on any scientific basis.