open access

https://hdl.handle.net/2115/39286

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

英語

postoperative overgrowth

2009-09

Elsevier Inc.

The Journal of Hand Surgery

34(7)

1242-1247

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 males and 5 females, 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 preoperation, immediately after surgery, and at follow-up. A difference in ulnar variance of more than 2 mm between these time points 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 MRI findings indicated lunate revascularization in all patients. Four of the 8 were recognized to have 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 significantly affect the clinical scores. Conclusions: The current results suggest the probability of occurrence in the 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 effects on clinical and other radiographic outcomes.

学術雑誌論文

Accepted Manuscript

0363-5023