Radial shortening osteotomy for treatment of Kienböck's disease.

Sixteen patients who had radial shortening osteotomy for treatment of Kienböck's disease were reviewed. Ulnar minus variance averaged 3.3 mm. All patients had conservative management that failed. Six were stage II, six were stage III, and four were stage IV. Average follow-up was 4.5 years. In all patients osteotomies united within 3 months. Thirteen patients were totally relieved of pain, and three had mild pain. Motion in the dorsal palmar plane improved, on average, 15 degrees. Grip strength increased 20% to 30% after the operation. Follow-up radiographs did not show continued collapse of carpal height or disease progression except in one patient. No radiographic evidence of degenerative changes at the distal radioulnar joint materialized. As a safe, reliable, and consistently successful method of managing Kienböck's disease, we strongly recommend radial shortening. Excluding the rare extended stage IV disease in which midcarpal arthritis with or without intercarpal instability is present, we have successfully applied this technique to all stages of Kienböck's disease. We recognize that further collapse and progression of disease may occur in stage III and IV disease, as was evident in one patient 5 years after osteotomy.