gms | German Medical Science

Purpose: To clarify long-term clinical and radiological results more than 8 years after dorsolateral biplane radial osteotomy for Kienböck's disease.

Methods: Twenty-one patients that had been classified as Lichtman stages II (7 wrist), IIIA (11 wrists) and IIIB (3) underwent dorsolateral radial biplane osteotomy for Kienböck's disease. This technique was performed to reduce radial inclination angle and the dorsal angle on the sagittal plane (ie, palmar tilt), thus achieving the dual effect of decompressing the lunate on the frontal and sagittal planes in Zero Variant cases. The mean follow up period was 10.3 years (8-17 y.). Clinical outcomes were quantified using the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the modified Mayo wrist score. Radiographic and Magnetic Resonance imaging (MRI) studies were performed in all patients preoperatively and at follow-up. A Statistical comparison of preoperative clinical, radiologic, and MRI studies with those performed before and after follow-up was performed using the wilcoxon test. Statistical significance was determined to be p< 0.05.

Results: There were 10 males and 11 females with a mean age of 32 years (range, 18-72). Fifteen patients were asymptomatic and the remaining six had mild occasional pain. No patients complained of constant pain (p< 0.001). Average preoperative grip strength was 24 Kg. and average postoperative was 54 Kg (p< 0.001). The mean range of extension and grip strength significantly improved. The mean Mayo wrist score and DASH scores were 94 (range, 80-100) and 5 (range, 0-15), respectively. At follow-up, no progression of the Lichtman stage was found in any patient. There was no significant progressive lunate collapse in any patient. The MRI in fifteen wrist showed increased signal intensity of the lunate; the remaining 6 wrists had no alteration in signal intensity of the bone.

Conclusions: Our study demostrated satisfactory clinical results after 8 or more years follow-up in patients who underwent dorsolateral radial osteotomy for Kienböck's disease. Although we found no improvement in signal intensity of the lunate in 6 wrists, unloading of the diseased lunate after dorsolateral radial osteotomy gives long-lasting symptom relief and may prevent lunate collapse.