Clinical and Radiological Results of Radial Shortening Osteotomy versus Proximal Row Carpectomy in Kienböck’s Disease

Research Article

Austin J Orthopade & Rheumatol. 2016; 3(2): 1032.

Clinical and Radiological Results of Radial Shortening Osteotomy versus Proximal Row Carpectomy in Kienböck’s Disease

Genç AS, Desteli EE and YunusImren*

1Department of Orthopedics and Traumatology, Samsun Gazi State Hospital, Turkey

2Department of Orthopedics and Traumatology, Usküdar State Hospital, Turkey

3YunusImren, MD, Department of Orthopaedics and Traumatology, Okmeydani Research and Training Hospital, Istanbul, Turkey

*Corresponding author: YunusImren, Okmeydani Training & Research Hospital, Istanbul, Turkey

Received: May 21, 2016; Accepted: July 19, 2016; Published: July 22, 2016


In this prospective study, we aimed to evaluate the clinical and radiological results of our patients treated with Radial Shortening Osteotomy (RSO) and Proximal Row Carpectomy (PRC) together with a short review of the literature. The study included 35 patients with the diagnosis of Kienbock disease RSO was performed for 17 patients and 18 patients underwent PRC. 15 of the patients had Lichtman Stage 2, 14 patients had Stage 3A and 6 patients had Stage 3B disease. Q-DASH Score, Preoperative and postoperative Carpal Height Ratio (CHR), revised CHR, stahl index, radial inclination values were noted. Preoperative and postoperative flexion-extension range of Motion (ROM) and ulnar deviation angles were also obtained. Nakamura’s clinical evaluation system was performed to each patient. Results of clinical evaluation revealed significant progression at postoperative sixth month follow-up. Our results showed clinical improvement following surgeries of both RSO and PRC for Lichtman Stage 2, 3a and 3b disease. We consider that experience and technical familiarity of the surgeon is key factor to decide the type of the procedure to be performed.

Keywords: Kienböck’s disease; Proximal row carpectomy; Radial shortening; Lichtman’ classification


Etiology of Kienbock disease remains unclear, this is mainly due to the rarity of the disease and lack of enough number of prospective studies. The treatment for Kienböck’s disease ranges from conservative modalities such as immobilisation to operative options such as radial shortening [1-4] ulnar lengthening [5] proximal row carpectomy [6] / silastic arthroplasty [7,8] intercarpal fusions [9] and revascularisation procedures [10,11].

Negative ulnar variance has been accepted as a predisposing factor to Kienbock disease, Hulten [12] in his study stated that in the case of negative ulnar variance, axial load on radial side of lunatum is increased which is a predisposing factor for lunatomalacia. Radial Shortening Osteotomy (RSO) is indicated in the case of negative ulnar variance as a joint leveling procedure [13-22]. Besides early stages of the disease, RSO has been found to be beneficial also in advanced stages [2,22]. Radial osteotomy has been found to increase vascularity of lunate and also made decompression [23-25]. Fragmantation and degenerative changes that occur particularly at proximal articular surface of lunate may ultimately lead collapse of the bone and the entire corpus. If carpal instability occurs in advanced disease, Proximal Row Carpectomy (PRC) can be considered [26]. PRC is a procedure used for the treatment of wrist arthritis, and has been reported to relieve pain and preserve wrist range of motion and grip strength [27-29]. Long-term outcomes of the most PRC and RSO procedures applied for treatment of Kienbock’s disease are satisfactory (Tables 1 & 2).