This study is a retrospective review of 11 teenage patients (11-19 years with a mean, 16 years) treated with a radial osteotomy for Kienbock’s disease. Two patients with zero or ulnar positive variance underwent a lateral closing wedge osteotomy and 9 patients with ulnar negative variance underwent a radial shortening with ulnar negative variance. Preoperative Lichtman stages included 3 stage II, 2 stage III-A, and 6 patients with stage III-B disease. All underwent preoperative MRI and 8 of 11 had postoperative MRI scans. The lateral closing wedge osteotomy reduced the radial inclination by 15 degrees and the radial shortening osteotomy normalized variance. At a mean follow-up of 50 months (range 12-117 months), 10 of 11 patients were pain-free. The remaining patient had moderate wrist pain on strenuous activity. The mean postoperative range of extension and flexion of the wrist increased from 81 + 13 degrees to 132 + 8 degrees. The grip strength of the affected side compared with the unaffected side improved from 38% + 6 % to 82 % + 7 %. There were 10 excellent results and 1 fair result. All osteotomies healed within 12 weeks. Radiographically, 8 patients had evidence of revascularization. In 5 of the 8 patients with a postoperative MRI, there was MRI evidence of return of normal marrow signal intensity of the lunate. One patient showed progression of degenerative changes at the radioscaphoid joint and there was no difference in signal intensity of the lunate in the one patient with a fair clinical outcome. No progression of Lichtman stage was found in 10 of 11 patients.
There have been many studies on the long-term outcome of radial osteotomies for Kienbocks disease in adult patients which on average have shown significant improvement in upwards of 80 % of patients, but progression of radiographic stage. This has prompted some authors to recommend revascularization procedures, especially in younger patients. This study suggests that radial osteotomies alone are effective in not only improving clinical outcomes as has been shown in the adult population, but also in preserving radiologic stage with evidence for revascularization of the lunate. In addition, there was no evidence for overgrowth of the radius in the skeletally immature patients.