Lunate revascularization after capitate shortening osteotomy in Kienböck's disease.

PURPOSE: The aim of surgical treatment in the early stages of Kienböck's disease is to decrease compressive loading of the lunate to promote revascularization. Capitate shortening osteotomy is one technique that has been advocated in Kienböck's disease with ulnar neutral or positive variance and Lichtman stage I to IIIA. The purpose of this study was to examine the revascularization process of the lunate after capitate shortening osteotomy.

METHODS

This was a retrospective study of 9 patients with Kienböck's disease with Lichtman stage II or IIIA and ulnar neutral or positive variance. I confirmed avascular necrosis of the lunate in all the patients by magnetic resonance imaging preoperatively. Capitate shortening osteotomy was performed through a dorsal approach and fixed with K-wires. I used magnetic resonance images with fat suppression to detect the revascularization of the lunate after surgery.

RESULTS

The mean follow-up was 12 months (range, 8-16 mo). All patients demonstrated partial revascularization of the lunate and the mean revascularization time was 4.7 months (range, 3-7 mo), which was interpreted as the beginning of the revascularization process.

CONCLUSIONS

Capitate shortening osteotomy is an efficient technique to induce the revascularization process in the early stages of Kienböck's disease.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.