Abstract: Introduction: Kienbock disease or avascular necrosis of the carpal bone, lunate, is not an uncommon disease but its treatment is still controversial. Treatment ranges from conservative management to proximal row capectomy and arthrodesis. Most commonly used procedure is radial shortening. This is a prospective study of Kienbock disease in which patients were managed by ulnar lengthening. Both the procedures unloads the lunate fossa and redistributes load to the scaphoid, and are indicated in early disease with negative ulnar variance.
The purpose of this study is to evaluate the functional outcome and disease progression; and to compare it with the available literature and other modalities of treatment.
Materials and Methods: 8 patients were operated for Kienbock disease by ulnar lengthening, between January 2008 to June 2012 in our institution. Patients who didn’t improve after a conservative treatment and stage 2 to stage 3b were included in the study. Patients with stage 4, with other systemic diseases are excluded from the study.
All the patients were evaluated pre-operatively clinically and radiologically and staged according to Litchman et al. Patients were followed up with a mean of 30 months post operatively for clinical and functional outcome. Assessment was done by quick DASH score, Visual analogue scale, and radiologically, for progression of the disease in subsequent follow up.
Results: Of 8 patients, 7 were followed-up for a mean of 30 months, sof which 6 patients were having good clinical (60% improvement in Quick DASH score) and radiological improvement, and 1 complained of no improvement subjectively, with no complication of non-union.
Summary: Ulnar lengthening osteotomy is a less demanding yet a good option in mild and moderate cases of Kienbock disease, who does not respond to conservative management. Our study did not experience complications like non-union as per previous literatures, and the functional outcome was good.
