RESULTS OF RADIUS SHORTENING PROCEDURES FOR KIENBOCK DISEASE: 33 WRISTS REVIEWED AT 12 YEARS

Abstract

Purpose: The few reports of long-term outcome of Kien-böck disease are helpful in establishing therapeutic indications.

Material and methods: Between 1970 and 1995, radius shortening procedures were performed in 44 patients. Among these 31 patients (eight women and 23 men), mean age 32 years (18–48) at surgery, with 33 operated wrists (18 right, 11 left, 2 bilateral, 19 dominant hands) were reviewed clinically (25 patients by an independent observer, three by their family physician) and radiologically (26 patients) or responded to a phone interview (five patients) at a mean 12 years follow-up (4–19 years). Four patients had died, nine were lost to follow-up. Before surgery the pain was intense (Michon scale): 32 grade I, one grade II. According to Lichtman, there were three grade I, seven grade II, eighteen grade IIIa and five grade IIIb. There was one case of haematoma and one reflex dystrophy, five late consolidations and five nonunions (three diaphyseal out of eight and two metaphyseal out of 25).

Results: The Michon pain score was variable, 11 grade IV, six grade III, nine grade II, but also seven grade I and four secondary arthrodeses. Postoperative amplitudes ere: flexion 50°, extension 53°, abduction 20°, adduction 29°, pronation 83°, supination 74°. Mean amplitudes increased for flexion (+12°), extension (+13°), abduction (+6°), and adduction (+11°), but decreased for pronation (−3°) and supination (−13°). The postoperative wrist fore (Jamar) was 32 kg (80° of other side). Eighteen patients were able to resume an occupational activity, requiring equivalent (14 patients, including 12 manual labourers) or greater (two patients) wrist force. At last follow-up the Lichtman classification was one grade I, four grade II, eight grade III1, three grade IIIb, and seven grade IV. The pre- to postoperative radiography comparison (26 wrists) showed two improvements, seven stabilisations, 14 aggravations, and three arthrodeses. There were also three cases of ulnocarpal impingement (one reoperated). Discussion: the factors predictive of good outcome were minimally advanced disease (Lichtman), little reduction in lunatum height (Stahl), absence of carpal collapse (McMurtry), absence of complication.

Conclusion: Shortening of the radius is an excellent procedure to Lichtman grade IIIa. Results are less satisfactory for grade IIIb but still acceptable compared with resections of the first row or intracarpal arthrodesis. To avoid the risk of ulnocarpal impingement, it would be preferable to reorient the glenoid or shorten the capitatum rather than shorten the radius in patients with a normal radioulnar index.