Triple-Modality Approach for Kienböck Disease (Stage II and IIIA): Outcomes of Distal Radius Core Decompression, Radial Shortening and Scapho-Capitate K-Wiring in 18 Patients.

Background

Early-stage Kienböck disease (KD), particularly stages II and IIIA, requires timely intervention to prevent progression and preserve wrist function. This study evaluates the outcomes of a triple-modality approach combining distal radius core decompression, radial shortening osteotomy (RSO) and scapho-capitate K-wiring.

Methods

A retrospective case series of 18 patients with stage II and IIIA KD were managed with this triple-modality approach at a single centre. Pain was assessed using the visual analogue scale score. Functional outcomes were assessed using the Modified Mayo Wrist Score (MMWS) and range of motion (ROM). Radiological staging was used to evaluate disease progression.

Results

The mean follow-up was 24 months. Postoperative outcomes showed significant improvements in MMWS, with an average score increase from 58.5 ± 8.2 preoperatively to 81.2 ± 6.7 postoperatively (p < 0.001). ROM improved significantly for both volar flexion (from 46.2° ± 7.8° to 54.5° ± 9.1°, p = 0.02) and extension (from 51.1° ± 8.3° to 59.7° ± 8.6°, p = 0.01). Radiological analysis revealed no disease progression in 88% of cases, with no instances of carpal collapse or advanced arthritis during follow-up.

Conclusions

The combination of distal radius core decompression, RSO and scapho-capitate K-wiring is a highly effective treatment for stage II and IIIA KD. This approach not only halts disease progression but also significantly improves wrist function and patient satisfaction. Level of Evidence: Level IV (Therapeutic).