Save or Salvage: Radial Shortening Osteotomy and Proximal Row Carpectomy in Kienböck’s Disease—A Descriptive Study

IF 2.4 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2026-09-01 Epub Date: 2026-05-26 DOI:10.1016/j.jhsa.2026.02.031

Tanis Quaife MD, BMSc, Ian Diffey MD, BSc, Lukas Hashem MD, Wrist and Elbow Research Canada (WECAN) Affiliates, Ruby Grewal MD, MSc

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引用次数: 0

Abstract

Purpose

To compare the mid- to long-term outcomes of radial shortening osteotomy (RSO) and proximal row carpectomy (PRC) in treating Kienböck’s disease, using patient-reported outcomes, functional measures, and rates of secondary surgery.

Methods

This multicenter cohort study evaluated 47 patients treated between 1998 and 2024 (31 RSOs, 16 PRCs). Radial shortening osteotomy and PRC groups included patients with Lichtman stage 2 through 4 as follows: RSO stage 2, 8 patients; stage 3A, 10 patients; stage 3B, 13 patients; stage 4, 0 patients; PRC stage 2, 0 patients; stage 3A, 3 patients; stage 3B, 9 patients; and stage 4, 4 patients. Primary outcomes included Patient-Reported Wrist Evaluation (PRWE); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); and satisfaction scores. Secondary outcomes were grip strength, range of motion, complications, and secondary surgeries. Subgroup comparison of primary and secondary outcomes in Lichtman stages 3A and 3B was performed.

Results

At a mean follow-up of 10.4 years, RSO patients demonstrated lower and therefore improved PRWE (23.5 [IQR, 12.0-52.5]) and QuickDASH (11.4 [IQR, 6.9-29.5]) scores with higher satisfaction (86%) compared with PRC (PRWE, 38.5 [IQR, 23.0-54.0]; QuickDASH, 23.0 [IQR, 13.6-43.2]; satisfaction, 62%). Radial shortening osteotomy and grip strength were similar between the groups. Reoperation rates were similar, although secondary surgeries in the RSO group were generally more limited than those in the PRC group (eg, hardware removal vs total wrist fusion). Subgroup descriptive comparison confirmed RSO’s benefits even in stages 3A/3B.

Conclusions

Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck’s disease, particularly in preserving joint function and patient satisfaction. Interestingly, RSO is also an effective joint-preserving option even in late-stage disease (Lichtman stages 3A/B), demonstrating lower PRWE and QuickDASH scores and higher satisfaction scores than PRC in these groups. Further large-scale studies are needed to confirm these findings and refine treatment protocols.

Type of study/level of evidence

Therapeutic IV.

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挽救或挽救：桡骨缩短截骨术和近行腕骨切除术治疗Kienböck疾病的描述性研究。

目的：比较桡骨缩短截骨术（RSO）和近行截骨术（PRC）治疗Kienböck疾病的中长期疗效，包括患者报告的预后、功能指标和二次手术率。方法：这项多中心队列研究评估了1998年至2024年间接受治疗的47例患者（31例rso， 16例prc）。桡骨截短和PRC组包括Lichtman 2 ~ 4期患者，RSO 2期8例；3A期，10例；3B期，13例；4期，0例患者；PRC期2 0例患者；3A期，3例；3B期，9例；第4阶段，4个病人。主要结局包括患者报告腕部评估（PRWE）；手臂，肩膀和手的快速残疾（QuickDASH）；满意度得分。次要结果是握力、活动范围、并发症和二次手术。对Lichtman期3A和3B的主要和次要结局进行亚组比较。结果：在平均10.4年的随访中，RSO患者的PRWE （23.5 [IQR, 12.0-52.5]）和QuickDASH （11.4 [IQR, 6.9-29.5]）评分较PRC （PRWE, 38.5 [IQR, 23.0-54.0]; QuickDASH, 23.0 [IQR, 13.6-43.2]；满意度，62%）较PRC (PRWE, 38.5 [IQR, 23.0-54.0]；两组间桡骨缩短截骨术和握力相似。再手术率相似，尽管RSO组的二次手术通常比PRC组更有限（例如，硬体取出与全手腕融合）。亚组描述性比较证实了RSO在3A/3B期的益处。结论：桡骨缩短截骨术治疗Kienböck疾病的效果至少与PRC相当，特别是在保持关节功能和患者满意度方面。有趣的是，即使在疾病晚期（Lichtman 3A/B期），RSO也是有效的关节保持选择，在这些组中显示出较低的PRWE和QuickDASH评分和较高的满意度评分。需要进一步的大规模研究来证实这些发现并完善治疗方案。研究类型/证据水平：治疗性IV。

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.