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Outcomes of Radial Shortening Osteotomy and Metaphyseal Core Decompression in Kienbock's Disease
Arush Patel, MD; Alidad Ghiassi, MD; Ryan Dellamaggiora, MD; Milan Stevanovic, MD, PhD; University of Southern California
University of Southern California, Los Angeles, CA, USA

There are multiple treatment options for the treatment of Kienbock’s disease but none have been shown to be clearly more effective. The purpose of this study was to report a retrospective review on the results of core decompression and radial shortening osteotomy for Kienbock stages II and IIIA. The type of surgery that was performed was determined based on the ulnar variance from regular x-rays. Patients with negative ulnar variance underwent a radial shortening (ROS) procedure performed, while those with neutral variance underwent a metaphyseal core decompression (MCD).

Ten patients were identified in the study, with an average age of 34 (range 18-73). The average follow-up was 27 months (5-51 months). Patients completed subjective questionnaires, which included Disability of Arm, Shoulder, and Hand score (DASH) and Visual analog scale (VAS) at the last follow-up visit. A second DASH and VAS were completed at the final follow up based on patients’s recollection of their symptoms. Bilateral upper extremities were examined for Range of Motion, grip strength and lunate tenderness. Radiographs were taken at time of last follow-up to evaluate for collapse and/or arthritic changes.

No post-operative complications occurred and no patient required additional surgery. Wrist flexion, extension, radial and ulnar deviation were decreased compared to opposite wrist. Decreased grip strength of 20 lbs (66% compared to opposite wrist). Disability of the Arm, Shoulder, and Hand scores decreased from a mean of 45.8 pre-operatively to 14.2 post-operatively. This difference of 31.6 was statistically significant. Visual analog scale decreased from a mean 7.9 pre-operatively to 2.4 post-operatively. The difference of 5.4 was statistically significant. RSO had a larger improvement in VAS (6.0) than MCD (4.8) after surgery, which was statistically significant. In terms of DASH scores, RSO had a larger improvement after surgery compared to MCD, 40.3 vs. 20.8, respectively. However, this difference was not statistically significant. One patient was noted to have progressive collapse of the lunate. All patients returned to their prior occupation without restrictions.

Although patients had decrease in ROM and grip strength compared to the contralateral wrist, all patients reported improvements in function and decrease in pain. Our study confirms that core decompression and radial shortening osteotomy remains an effective option for treatment for stages II and IIIA patients. Additionally, we recommend ROS for Kienbock’s disease with positive ulnar variance and MCD for patients with neutral variance.

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