Isolated capitate shortening osteotomy for the early stage of Kienböck disease with neutral ulnar variance.
BACKGROUND
Kienböck disease is an aseptic necrosis of the lunate for which the treatment is still debated, particularly in the rare cases with neutral ulnar variance. One option is to perform a capitate shortening osteotomy associated with a capitate-hamatum arthrodesis. The aim of this study was to evaluate a simple capitate osteotomy without arthrodesis.


METHODS
This is a retrospective study of 11 cases. All patients had a mild form of Kienböck disease (stage I to IIIA according to the classification of Lichtman). A shortening capitate osteotomy was performed through a dorsal medial approach and fixed with staples.


RESULTS
At the final follow-up evaluation (mean, 67.4 months), the mean visual analogue scale score was 1.7 (range, 0 to 7). Based on the Nakamura score, the authors obtained six good, two fair, and three poor results. Mean strength improvement was 25 percent compared with the healthy side, and the authors observed no change in range of motion. The radiologic follow-up showed no difference in either the Stahl or the Youm index between preoperative and postoperative measurements. No complication was observed; however, in two cases, the result was evaluated as poor and a revision procedure was performed.


CONCLUSIONS
This technique is a simple and reliable method with which to manage the early stages of Kienböck disease with neutral ulnar variance.
Gay
Andre M
AM
Marseille, France From the Department of Plastic and Reconstructive Surgery, La Conception Hospital, the Department of Orthopedic Surgery, Sainte Marguerite Hospital, and the Department of Orthopedic Surgery, La Timone Enfant Hospital.
Parratte
Sebastien
S
Glard
Yann
Y
Mutaftschiev
Nicolas
N
Legre
Regis
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D051224:Capitate Bone / Q000601:surgery*; D002348:Carpal Bones / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy; D010147:Pain Measurement; D011859:Radiography; D012189:Retrospective Studies; D014955:Wrist Joint / Q000000981:diagnostic imaging; D055815:Young Adult