Corrective Osteotomy for Treatment of Wrist Arthritis

Introduction

Radial shortening osteotomy is optional treatment for early stage of wrist arthritis especially for the arthritis being predisposed by Kienbock disease in stages I to IIIA. The usefulness of this procedure in more advanced stages of the disease is controversial.

Method

In this study, 6 cases of stage IIIB and IV of Kienbock disease underwent radial shortening osteotomy and were followed for a mean period of 28.5 months (13 to 38 mo). 3 patients had stage IIIB and 3 patients had stage IV disease. 3 of the affected wrists were on the dominant side. All patients were evaluated clinically and radiologically at last follow-up. Modified Mayo Score was used for clinical evaluation. The measured radiologic parameters included carpal height ratio, Stahl index, and radioscaphoid angle.

Result

In stage IIIB, 100% of 3 cases were good. In stage IV, 1 case is good and 2 cases are poor. The mean range of flexion-extension was 84.4% of the unaffected side.

Discussion

Considering the percentage of preserved motion, this procedure seems to be a good alternative to partial fusion for stage IIIB when the patient is willing to preserve more degrees of motion. Although the number of patients with stage IV disease was limited in this study, there are not so good result in stage IV.

Conclusions

Radius shortening is a trustful procedure in the treatment of early stage arthritis especially in the category of Kienbock disease.