Lateral closing wedge osteotomy of the distal radius for advanced stages of Kienböck's disease.

Seven patients with advanced Kienböck's disease, stage III-B and IV by Lichtman classification, who were treated with lateral closing wedge osteotomy of the distal radius were evaluated clinically and radiographically. The clinical results were correlated with radiographic changes. Five patients had stage III-B and 2 had stage IV disease; average follow-up period was 50 months (range, 24-93 months). Clinical results were good in 4 patients, fair in 2 patients, and poor in 1 patient based on Nakamura's postoperative clinical scoring system. The carpal-ulnar distance ratio and lunate-covering ratio increased and the radioscaphoid angle improved significantly. The improvements in radioscaphoid angle and Nakamura's postoperative clinical score showed a significant correlation. The satisfactory clinical outcome of lateral closing wedge osteotomy of the distal radius for advanced-stage Kienböck's disease can be attributed to the effects of the increased lunate-covering ratio and the improved radioscaphoid angle on carpal alignment.