title: Radiographic Progression of Kienböck Disease: Radial Shortening Versus No Surgery.
abstract: OBJECTIVE
  The natural course of the pathophysiology of Kienböck disease is uncertain. Shortening of the radius is believed to modify the pathophysiology by addressing mechanical influences on the lunate. The aim of this study was to compare the radiographic progression of Kienböck disease among patients who had radial shortening osteotomy and patients who had no surgical treatment, with a minimum 1-year interval between radiographs.
  
  
  METHODS
  Among 207 patients with Kienböck disease, we included all 48 eligible patients who had either radial shortening osteotomy or nonsurgical treatment and 2 sets of wrist radiographs available a minimum of 1 year apart. We compared changes in carpal height ratio, Stahl index, and carpal angles between the 2 sets of radiographs and between radial shortening osteotomy and nonsurgical treatment.
  
  
  RESULTS
  We found, on average, a small decrease in the carpal height ratio and the Stahl index in patients who did and did not have surgery, with no differences between the 2 groups. Nearly half of the patients had no decrease in the carpal height ratio and/or the Stahl index.
  
  
  CONCLUSIONS
  Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment. Future research might address the probability of and factors associated with radiographic progression of Kienböck disease.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Wouter F
authors.initials: WF
authors.lastname: van Leeuwen
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX. Electronic address: david.ring@austin.utexas.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D015331:Cohort Studies; D000072700:Conservative Treatment / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011379:Prognosis; D011859:Radiography / Q000379:methods; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Kienböck disease; lunatomalacia; natural course; progression; radial shortening