American Association for Hand Surgery
Theme: Beyond Innovation

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Clinical and MRI Evaluation of Kienböck's Disease Treated by "Camembert" Radial Osteotomy. Follow-Up 7 Years
Emmanuel J Camus, MD1,2; Luc Van Overstraeten, MD, PhD2,3; Frédéric Schuind, MD, PhD2;
1SELARL Chirurgie de la Main, Lesquin, France, 2Brussels Free University, Brussels, Belgium, 3HFSU, Tournai, Belgium

Camembert wedge osteotomy shortens the radius at lunate fossa (Fig. 1-2). The approach is dorsal.

The goal of this osteotomy is to unload the lunate by redirecting most of the compression forces towards the scaphoid. The authors reviewed a series of patients with an average follow-up of 7 years.
Thirteen patients underwent surgery between 2002 and 2012. Three patients were lost to follow-up. The series shows the results of eleven wrists on six men and four women. The average age of the patients was 40.6 years. In 5 cases of ulna plus index, an ulnar shortening osteotomy according to Sennwald was associated.
There were two Lichtman stage 1 patients, 5 stage 2, 4 stage 3A. MRI showed 1 case of lunate edema and 10 cases of lunate heterogeneous.
Preoperatively, the flexion/extension arc of the wrist was 95°, the radioulnar inclination 38°, the prognosupination 172°. Grip was 13.8 kgf, EVA pain 8.2, PRWE score 82.3, SANE score 26.6%.
All osteotomies consolidated in 3 months. The extension (+9°), ulnar deviation (+10°), grip (+15kgf), PRWE (-57) and SANE (+53) scores improved significantly. The pronosupination did not change significantly, with or without associated ulnar osteotomy.
The MRI aspect of the lunate improved 10 times out of 11. Clinical results were excellent and good in 8 cases, average in 2 and poor in 1 case. The latter was due to lunocapitate arthritis. The most common radial shortening osteotomies give good clinical results in 1/3 to 2/3 of cases. But they don't avoid degenerative changes in the lunatum every other time. The goal of the osteotomy camembert is not to heal the lunatum, but to protect it from fractures by compression, and to maintain at best its anatomy. This series shows good results without worsening the height of the lunatum. This osteotomy, unloading the lunatum but not the scaphoid, seems effective to protect the lunatum. Most wrists are permanently improved. The radiological aspect improves in most cases, and it is likely that some lunatum will heal. Camembert osteotomy can be used in combination with Sennwald ulnar shortening when the ulnar variance is positive, or when radial osteotomy is difficult to close.
The results on our 11 oldest cases are encouraging. We propose this procedure for the Lichtman 1-2-3A stages if there are no cartilage or ligament injuries.


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