Elsevier

The Journal of Hand Surgery

Volume 34, Issue 7, September 2009, Pages 1242-1247
The Journal of Hand Surgery

Scientific article
Radial Overgrowth After Radial Shortening Osteotomies for Skeletally Immature Patients With Kienböck's Disease

https://doi.org/10.1016/j.jhsa.2009.04.028Get rights and content

Purpose

We hypothesized that radial shortening osteotomy (radial shortening) for skeletally immature patients with Kienböck's disease would induce overgrowth of the radius. The purpose of this study was to determine the effect of radial shortening on radial growth in skeletally immature patients with Kienböck's disease and to clarify the relationship between the postoperative growth alterations and the clinical results.

Methods

Eight wrists of 8 skeletally immature patients with Kienböck's disease were treated with radial shortening. There were 3 boys and 5 girls, ranging in age from 11 to 18 (mean, 14) years old. All patients presented with open physis and negative ulnar variance. The length of the radial shortening equaled the amount of negative ulnar variance. Clinical assessment was based on the modified Nakamura scoring system. Radiographic assessment, including Lichtman's stages, ulnar variance, carpal height ratio, radial inclination, and volar tilt, was performed before surgery, immediately after surgery, and at follow-up. A difference in ulnar variance of more than 2 mm between these 3 measurements was considered to be overgrowth. Statistical comparisons were performed using paired t-tests.

Results

At a mean follow-up period of 69 months, the mean clinical score was 19.7 of 21 maximum points, with all wrists rated as excellent. Radiographically, no progression of Lichtman stage was found in any patient. At follow-up, the x-ray and magnetic resonance imaging findings indicated lunate revascularization in all patients. Four of the 8 had overgrowth in the operated radius. On the other hand, other radiographic parameters showed no significant changes at follow-up. The occurrence of postoperative radial overgrowth did not notably affect the clinical scores.

Conclusions

The current results suggest the probability of overgrowth of the radius in skeletally immature patients with Kienböck's disease treated with radial shortening. The postoperative radial overgrowth after this osteotomy had no effect on clinical and other radiographic outcomes.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

We retrospectively identified and reviewed all skeletally immature patients with symptomatic Kienböck's disease who were considered for radial shortening from 1990 to 2004. Chart reviews identified 8 patients. Three surgeons carried out radial shortening for the 8 patients with negative ulnar variance. Hospital medical records and preoperative and postoperative radiographs obtained at regular follow-ups were collected in order to evaluate the clinical and radiographic findings. There were 3

Clinical assessments

At a mean follow-up of 69 (range, 36–117) months, 6 of the 8 patients were free from pain, and the remaining patients had mild wrist pain on strenuous activity. No patient had pain at the distal radioulnar joint or at the osteotomy site. The mean postoperative range of extension and flexion of the wrist increased significantly, from 91° ± 16° to 151° ± 21° (p < .01). The grip strength of the affected side compared with the unaffected side improved from 43% ± 13% to 104% ± 10% (p < .01). Based

Discussion

The first aim of this study was to determine the effect of radial shortening on radial growth in skeletally immature patients with Kienböck's disease. At a mean follow-up of 69 months, in standard radiographs, we recognized that 4 of the 8 patients (50%) had radial overgrowth in the affected side. There were no other findings indicating radial deformities after this surgery. To our knowledge, only 1 case report has demonstrated 8-mm overgrowth at 80 months after radial shortening for Kienböck's

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