Does Combined Radial Wedge and Shortening Osteotomy Work in Advanced Kienbock's Disease? - A Comparative Study with Scaphocapitate Arthrodesis
Seong-Hwan Woo, M.D., Yeong-Seub Ahn, M.D., Ph.D. and Myung-Sun Kim, M.D., Ph.D., Chonnam National University Hospital, Gwangju, Korea, Republic of (South)
Although various surgical techniques have been reported for the treatment of advanced Kienbock's disease (Litchman stage IIIB and above), the appropriate operative treatment is still being debated.
This study compared the clinical and radiological outcomes of radial wedge and shortening osteotomy (RWSO) and scaphocapitate fusion (SCF) in the treatment of advanced Kienbock's disease (above type IIIB) with a minimum of 3 years of follow up.
We analyzed the data from 16 and 13 patients who underwent RWSO and SCF, respectively. The average follow-up period was 48.6±12.8 months. Clinical outcomes were evaluated using the flexion-extension arc, grip strength, Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Visual Analogue Scale (VAS) for pain. The following radiological parameters were measured: ulnar variance (UV), carpal height ratio (CHR), radioscaphoid angle (RSA), and Stahl index (SI). Osteoarthritic changes in the radiocarpal and midcarpal joints were evaluated using computed tomography (CT).
Clinically, both groups showed significant improvements in the grip strength, and DASH and VAS scores at final follow up. However, regarding the flexion-extension arc, the RWSO group showed a significant improvement, while the SCF group did not (p<0.001 and p=0.249, respectively). Radiologically, compared to the preoperative values, the CHR results improved at final follow up in the RWSO and SCF groups (p=0.007 and p=0.016, respectively). There was no statistically significant difference in the degree of CHR correction between the 2 groups (p=0.068). By the final follow-up visit, none of the patients in either group had progressed from Lichtman stage IIIB to stage IV.
In conclusion, when considering the recovery of wrist joint range of motion, we propose that RWSO is a superior operative treatment when compared to SCF for advanced Kienbock's disease.
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