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Kienböck’s disease with non-negative ulnar variance

Treatment with combined radial wedge and shortening osteotomy

Lunatumnekrose ohne negative Ulnavarianz

Behandlung mit kombinierter radialer Keil- und Verkürzungsosteotomie

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Abstract

Purpose

There are only few studies that focused on Kienböck’s disease with non-negative ulnar variance, even though many surgical procedures have been introduced. A combined radial wedge and shortening osteotomy was carried out for Kienböck’s disease with non-negative ulnar variance. The purpose of this article is to report the results of this procedure by analyzing the clinical and radiological data.

Material and methods

The data for patients with Kienböck’s disease who were treated by combined radial wedge and shortening osteotomy between 2007 and 2016 were retrospectively reviewed. A total of 18 patients (8 males, 10 females), average age 37 years, were included in this study and the mean follow-up period was 22.3 months. Radiological analysis included Lichtman stage, ulnar variance, radial inclination, carpal height ratio, radioscaphoid angle and Stahl’s index. Clinical analysis included range of motion (ROM), visual analog scale (VAS) score, grip power, modified Mayo wrist score (MMWS), and disabilities of arm, shoulder and hand (DASH) score.

Results

Preoperative radiological analysis showed 16 cases of Lichtman stage IIIA and 2 cases of stage IIIB. Preoperative ulnar variance was +0.51 mm, radial inclination was 27.7o, carpal height ratio was 0.49, radioscaphoid angle was 52.8o and Stahl’s index was 0.42. All patients had solid union at the osteotomy site. At the final follow-up the average ulnar variance was +1.9 mm, radial inclination was 16.5o, carpal height ratio was 0.48, radioscaphoid angle was 58.2o and Stahl’s index was 0.36. Clinical analysis showed that the average dorsiflexion of the wrist was increased by 8.4o and palmar flexion of the wrist was increased by 29.6o. Grip power was increased by an average of 9.9 kg. Average VAS at the final follow-up was 1.0, DASH score was 4.3, and modified Mayo wrist score was 78.1.

Conclusion

Radial wedge and shortening osteotomy can be recommended as an option for Kienböck’s disease with non-negative ulnar variance, based on acceptable results from this study.

Zusammenfassung

Zielsetzung

Bislang legen nur wenige Studien ihren Fokus auf die Lunatumnekrose mit Nichtminusvariante der Ulna, obwohl zahlreiche chirurgische Verfahren eingeführt wurden. Eine kombinierte radiale Keil- und Verkürzungsosteotomie wurde bei Lunatumnekrose mit Nichtminusvariante der Ulna durchgeführt. In der vorliegenden Arbeit sollen die Ergebnisse dieses Verfahrens vorgestellt werden. Dazu wurden klinische und radiologische Daten analysiert.

Material und Methoden

Retrospektiv wurden die Daten von Patienten mit Lunatumnekrose analysiert, bei denen zwischen 2007 und 2016 eine kombinierte radiale Keil- und Verkürzungsosteotomie durchgeführt worden war. Insgesamt 18 Patienten (8 männlich, 10 weiblich) in einem Durchschnittsalter von 37 Jahren wurden in die vorliegende Studie eingeschlossen. Die mittlere Follow-up-Dauer betrug 22,3 Monate. Für die radiologische Analyse wurden das Lichtman-Stadium, die Ulnarvarianz, die Radiusneigung, das karpale Höhenverhältnis („carpal height ratio“), der radioskaphoidale Winkel und der Stahl-Index berücksichtigt. Die klinische Analyse beinhaltete den Bewegungsumfang, eine visuelle Analogskala (VAS), die Griffkraft, den modifizierten Mayo-Wrist-Score (MMWS) und Funktionseinschränkungen von Arm, Schulter und Hand (Disability of Arm Shoulder and Hand [DASH]).

Ergebnisse

Die präoperative radiologische Untersuchung ergab 16 Fälle mit Lichtman-Stadium IIIA und 2 Fälle mit Stadium IIIB. Die präoperative Ulnarvarianz betrug +0,51 mm, die Radiusneigung 27,7°, das karpale Höhenverhältnis 0,49, der radioskaphoidale Winkel 52,8° und der Stahl-Index 0,42. Bei allen Patienten bestand eine feste Verbindung an der Osteotomiestelle. Im letzten Follow-up betrug die Ulnarvarianz durchschnittlich +1,9 mm, die Radiusneigung 16,5°, das karpale Höhenverhältnis 0,48, der radioskaphoidale Winkel 58,2° und der Stahl-Index 0,36. Die klinische Analyse ergab, dass die durchschnittliche Dorsalflexion des Handgelenks um 8,4° und die Palmarflexion des Handgelenks um 29,6° erhöht war. Die Griffkraft war um durchschnittlich 9,9 kg gesteigert. Der durchschnittliche VAS-Wert betrug beim letzten Follow-up 1,0, der DASH-Score 4,3 und der modifizierte Mayo-Wrist-Score 78,1.

Schlussfolgerung

Basierend auf den akzeptablen Ergebnissen der vorliegenden Studie kann die radiale Keil- und Verkürzungsosteotomie als Therapieoption bei Lunatumnekrose mit Nichtminusvariante der Ulna empfohlen werden.

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Abbreviations

DASH:

Disabilities of arm, shoulder and hand score

MMWS:

Modified Mayo wrist score

MRI:

Magnetic resonance imaging

VA-LCP:

Variable angle locking compression plate

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Korea

    In-Tae Hong, Soohyun Lee, Gyu chol Jang, Gotak Kim & Soo-Hong Han MD, PhD

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  1. In-Tae Hong
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Correspondence to Soo-Hong Han MD, PhD.

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I.-T. Hong, S. Lee, G.c Jang, G. Kim and S.-H. Han declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from subjects who might be identifiable from information or images shown in this article or their legal guardians.

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Hong, IT., Lee, S., Jang, G.c. et al. Kienböck’s disease with non-negative ulnar variance. Orthopäde 48, 96–101 (2019). https://doi.org/10.1007/s00132-018-3641-5

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