Radial shortening.
The association of a negative ulnar variance in individuals with Kienböck's disease provides the basic rationale for a radial shortening osteotomy in the treatment of this particular condition. Many biomechanical studies have demonstrated both high compressive and tensile forces on the lunate during normal ranges of wrist motion. An osteotomy to realign the radiocarpal joint by shortening the radius attempts to lessen the presumably increased compressive forces on the lunate in patients who have a negative ulnar variance. By "unloading" the lunate through this procedure, the possibility for secondary revascularization exists. It appears that the lunate "stands still in time" after a radial shortening, with no significant further deterioration being noted by objective measures. Nevertheless, evidence to concretely support revascularization is sketchy and subjective. The radiographic observation of lunate collapse (stage III disease) does not, by itself, represent a contraindication to the use of a radial shortening. In fact, excellent symptomatic relief with improvement in objective parameters is noted in patients with stage III disease. A distinct advantage of radial shortening, in all stages of disease, is the remote nature of the procedure itself, allowing quick postoperative recovery and the ability to undertake more complex carpal reconstructive procedures should the need arise. Radial shortening represents a relatively simple extra-articular procedure with excellent relief of pain, increased postoperative grip strength, and postoperative improvement of range of motion. Although some subjective evidence of revascularization of the lunate has been presented by several investigators, it does not appear that the external architecture of the lunate (be it collapsed or of normal height) improves or deteriorates with time after a radial shortening.(ABSTRACT TRUNCATED AT 250 WORDS)
Weiss
A P
AP
Department of Orthopaedics, Brown University School of Medicine, Providence, Rhode Island.
D002348:Carpal Bones; D006801:Humans; D009985:Orthopedics / Q000379:methods; D010007:Osteochondritis / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications; D011884:Radius / Q000601:surgery*