[Long-term results of 9 cases of elongation of the ulna in treatment of Kienböck's disease].
The treatment of Kienböck's disease is currently controversial. Ulnar shortness is usually considered to be the main etiological factor. This observation is the basis for distal radio-ulnar joint levelling procedures, which means the radial shortening osteotomy and ulnar lengthening osteotomy. Several authors have reported their experience on the topic, but there are very few studies with sufficient follow-up to evaluate the value of the operative procedure on the carpus. We report a 9 patient review series following an ulnar lengthening procedure for Kienböck's disease. The average follow-up was 24 years (range: 12 to 21 years). There were 7 men and 2 women and the average age was 30 years at the time of the operation. The dominant side was affected 6 times out of 9.6 heavy workers and 3 light workers are reported. Four out of 9 patients had a history of trauma. The surgical procedure was a stair-step distal diaphyseal ulnar lengthening with distraction and osteosynthesis with a plate, without bone graft. The selected patients underwent a clinical examination of wrist pain, mobility and strength in comparison with the non-operated side. All patients under went a standard radiographical examination in neutral position. The analysis of the series shows that ulnar lengthening was successful for all patients especially on the strength and pain level, whereas mobility deteriorated. Without being able to reconstitute the normal morphology of the lunate bone, the procedure was able to stop the long-term natural course of the disease leading to carpus collapse and arthrosis without radio-carpal disturbance. Excessively long consolidation times and a very high pseudarthrosis rate are reported. Ulnar shortness does not seem to be an etiological factor. The natural history of the disease is perhaps not as bad as previously thought. The impact of the procedure on the distal radio-ulnar joint and the ulnar impaction syndrome in excessive lengthening are serious issues which need to be resolved. The procedure is preferably indicated in young patients, at the beginning of the disease, with a negative distal radio-ulnar variance. The Linscheid operative technique is recommended.
Ducarmois
P
P
Service d'Orthopédie et Traumatologie, Clinique Notre-Dame, Charleroi, Belgique.
Van Innis
F
F
D000328:Adult; D000367:Age Factors; D001852:Bone Lengthening / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D010007:Osteochondritis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010027:Osteotomy; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014945:Wound Healing; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery