[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

Anterior dislocation of the lunate due to a high-energy trauma.

Semilunate and perilunate dislocation is an injury that mostly occurs when the subject is exposed to a high-energy trauma. Considered severe, it compromises the stability and function of the wrist. The case presented is that of a 50-year-old male patient who after having a motorcycle accident arrived at the ER with neurovascular affectation, swelling, deformity and a considerable decrease of the wrist joint movement. He was also referring severe pain. A Henry (Volar) intervention was done with the help of external fixation of the lunate, followed by K-wire fixation, once a prior closed reduction was unsuccessfully attempted. The scaphoid was connected to the semilunate, and then the latter with the capitate. Ligament reconstruction followed, and stability was clinically confirmed with an X-ray. Although improvement of symptomatology was observed during the follow-up analysis, motion of the wrist remained limited. Even with the best treatment, in terms of functionality, this type of injury presents a poor prognosis.

La luxación semilunar y perilunar es una lesión que se produce principalmente cuando el sujeto está expuesto a un traumatismo de alta energía. Considerada grave, compromete la estabilidad y la función de la muñeca. El caso presentado es el de un paciente varón de 50 años que tras sufrir un accidente de motocicleta llegó a urgencias con afectación neurovascular, tumefacción, deformidad y una considerable disminución del movimiento articular de la muñeca. También refería fuertes dolores. Se realizó una intervención de Henry (Volar) con la ayuda de fijación externa del lunar, seguida de fijación con agujas de Kirschner, una vez que se había intentado sin éxito una reducción cerrada previa. El escafoides se conectó con el semilunar y luego éste con el capitado. A continuación se reconstruyó el ligamento y se confirmó clínicamente la estabilidad con una radiografía. Aunque se observó una mejora de la sintomatología durante el análisis de seguimiento, el movimiento de la muñeca seguía siendo limitado. Incluso con el mejor tratamiento, en términos de funcionalidad, este tipo de lesión presenta un mal pronóstico.

[Perilunares dislocations of minor arch what is the best therapeutic method?] / Luxaciones perilunares de arco menor ¿cuál es el mejor método terapéutico?

INTRODUCTION: Carpal dislocations and fracture-dislocations are uncommon injuries and represent approximately 5-7% of all wrist injuries, or about 10% of all carpal injuries. Multiple treatments are proposed to treat these injuries. The aim of our paper is to review the evidence about the treatment of lesser arc perilunate dislocations and to assess the results of the different therapeutic methods. MATERIAL AND METHODS: A systematic review was carried out through the electronic search engines PubMed, Bireme and Timbó. The search reached a total of 898 articles, according to the inclusion and exclusion criteria, 16 works were selected to carry out our systematic bibliographic review. RESULTS: The majority of the studies analyzed are retrospective case series studies, level of evidence IV. Our results are based on the extraction of data only from minor arc lesions of said works. Five subgroups were performed according to the type of treatment to analyze the results. DISCUSSION: The different therapeutic methods were analyzed and clinical, functional and radiographic parameters were compared during follow-up. CONCLUSION: There are no significant differences, in terms of the scores used, between closed reduction and percutaneous fixation or open reduction and ligament repair.

INTRODUCCIÓN: Las luxaciones y luxo-fracturas del carpo son lesiones de baja incidencia, constituyendo aproximadamente 5-7% de todas las lesiones de la muñeca o alrededor de 10% de todas las lesiones del carpo. Los tratamientos propuestos para tratar dichas lesiones son múltiples. El objetivo de nuestro trabajo es revisar la evidencia acerca del tratamiento de las luxaciones perilunares de arco menor y valorar resultados de los diferentes métodos terapéuticos. MATERIAL Y MÉTODOS: Se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed, Bireme y Timbó. La búsqueda alcanzó un total de 898 artículos, de acuerdo con los criterios de inclusión y exclusión se seleccionaron 16 trabajos para realizar nuestra revisión bibliográfica. RESULTADOS: La mayoría de los estudios analizados son estudios tipo serie de casos retrospectivos, nivel de evidencia IV. Nuestros resultados se basan en la extracción de datos únicamente de las lesiones de arco menor de dichos trabajos. Se realizaron cinco subgrupos según tipo de tratamiento para analizar los resultados. DISCUSIÓN: Se analizaron los diferentes métodos terapéuticos y se compararon parámetros clínicos, funcionales y radiográficos en el seguimiento. CONCLUSIÓN: No existen diferencias en cuanto a los puntajes utilizados entre la reducción cerrada y fijación percutánea o reducción abierta y reparación ligamentaria.

Luxación inveterada del semilunar / Inveterate Lunate Dislocation

RESUMEN Las fracturas-luxaciones carpianas son lesiones poco frecuentes que ocurren tras traumatismos de alta energía y que, inicialmente, muchas veces pasan desapercibidas. Se presenta un paciente de 32 años de edad, masculino, que había sido atendido seis semanas antes en la consulta de trauma tras caer de una altura aproximada de 6 metros. Se diagnosticó luxación aislada del semilunar y se le realizó carpectomía parcial. La evolución fue satisfactoria, el paciente se incorporó a su vida social activa a las 16 semanas del acto operatorio. Tras un año de evolución presentó dolor leve y ocasional(AU)

ABSTRACT Carpal fracture-dislocations are rare injuries that occur after high-energy trauma and that, initially, often go unnoticed. A case of a 32-year-old male patient is reported, he had been treated six weeks earlier in the trauma clinic after falling from a six meter height approximately. An isolated lunate dislocation was diagnosed and partial carpectomy was performed. The evolution was satisfactory, the patient joined his active social life 16 weeks after the operation. After a year of evolution, he showed mild and occasional pain(AU)

Luxación palmar divergente del escafoides y semilunar: reporte de caso / Palmar divergent dislocation of the scaphoid and lunate: case report

Reportamos el caso de un hombre de 61 años de edad quien presentó una luxación palmar divergente del escafoides y semilunar de la muñeca derecha secundario a trauma por caída de una escalera en su casa, quien fue atendido a las 24 horas del accidente, se le realizó una resección de los dos huesos (desvascularizados completamente), y se redujo el hueso grande en la fosa semilunar del radio más reparación de la cápsula articular y los ligamentos palmares radiocarpales. Al control del primer año el resultado ha sido satisfactorio, con un buen desempeño de su actividad laboral, y con una congruencia de la articulacion radio hueso grande y estabilidad completa de la muñeca. Nivel de Evidencia: IV

We report the case of a 61-year-old man who presented a Palmar divergent dislocation of the scaphoid and lunate of the right wrist secondary to trauma due to the fall of a ladder in his house, who was seen 24hours after the accident, he underwent a resection of the two bones (completely devascularized), and the Capitate bone was reduced in the lunate fossa of the radius by adding a repair of the joint capsule and the radiocarpal palmar ligaments. After the first year of follow up the result has been broadly satisfactory, with good performance of his working activity, and with a congruence of the Radial-Capitate joint with complete stability of the wrist. Evidence Level: IV

Role of Ligament Stabilizers of the Proximal Carpal Row in Preventing Dorsal Intercalated Segment Instability: A Cadaveric Study.

BACKGROUND: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability. METHODS: Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DIC) and scaphoid insertion (DIC) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline. RESULTS: Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DIC significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DIC+DIC produced dorsal intercalated segment instability. CONCLUSIONS: In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DIC+DIC). CLINICAL RELEVANCE: When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft / Capsulodese dorsal associada à reconstrução assistida por artroscopia do ligamento escafossemilunar com enxerto do tendão do músculo palmar longo

ABSTRACT OBJECTIVES: To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. METHODS: From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. RESULTS: The follow-up time was 12 months (3-17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1-6). DASH was 6.50/100 (1-30). The time to work return work was 4.42 months (2-17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities. The preoperative SL gap was 4.29 mm (2-7); in the postoperative period, it was 1.79 mm (1-4). The DISI deformity was present in ten patients with SL angle > 70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. CONCLUSION: The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

RESUMO OBJETIVOS: Mensurar a qualidade de vida, o tempo de retorno ao trabalho, os resultados clínicos, funcionais e radiográficos dos pacientes submetidos à capsulodese dorsal associada à reconstrução ligamentar escafossemilunar assistida por artroscopia. MÉTODOS: De janeiro de 2015 a setembro de 2016, 14 pacientes, esqueleticamente maduros, adultos, com dissociação escafolunar (SL), foram submetidos ao tratamento cirúrgico com o procedimento de reconstrução do ligamento escafossemilunar assistido por artroscopia com a nova técnica proposta neste estudo. Todos os pacientes foram avaliados pelo setor de terapia ocupacional em intervalos regulares de pós-operatório e fizeram a mesma sequência de reabilitação. Os parâmetros analisados foram: arco de movimento (ADM), Disability Arm, Shoulder and Hand (Dash), escala visual analógica (EVA) e análise radiográfica pré e pós-operatória para visualizar o espaço escafolunar (sinal de Terry-Thomas) e deformidade em Dorsal Intercalated Segment Instability (DISI) pré e pós-operatória. Descrição das complicações e o tempo de retorno ao trabalho. RESULTADOS: O tempo de seguimento foi de 12 meses [3-17]. O ADM foi em média 321,07° (96,9% do lado normal). O valor da avaliação subjetiva da dor (VAS) foi 1,79/10 [1-6]. A mensuração da qualidade de vida pelo Dash foi de 6,50/100 [1-30]. O tempo de retorno ao trabalho foi de 4,42 meses [2-17]. Quanto às complicações, uma paciente evoluiu com SLAC e foi submetida à artrodese dos quatro cantos um ano após a reconstrução ligamentar. Evoluiu com melhoria da dor e está com o ADM do punho funcional, mas ainda não retornou às atividades profissionais. O intervalo do SL (gap) pré-operatório foi de 4,29 mm [2-7] e o pós-operatório foi de 1,79 mm [1-4]. A deformidade DISI estava presente em dez pacientes, com um ângulo SL acima de 70° (pré-operatório), e foi corrigida após a cirurgia em todos os pacientes. SLAC estágio I foi identificado em um paciente. A artroscopia foi feita em todos os casos. A instabilidade SL foi classificada como um grau Geissler III em quatro casos e grau IV em dez casos. CONCLUSÃO: A nova abordagem (capsulodese dorsal associada à reconstrução ligamentar escafossemilunar assistida por artroscopia) apresentada neste estudo é segura e eficaz no tratamento da dissociação escafolunar, já que apresenta resultados radiográficos, clínicos e funcionais satisfatórios, demonstra baixas taxas de complicações, permite o retorno às atividades sociais e profissionais e aumenta a qualidade de vida desses pacientes.

Foreign-Body Reaction and Osteolysis in Dorsal Lunate Dislocation Repair With Bioabsorbable Suture Anchor.

Background: In recent years the use of biodegradable suture anchors for treating tendon and ligament pathology in hand surgery became popular. These materials are biocompatible, radiolucent, and load sharing, as they incrementally transfer load to surrounding bone during the resorption process. Despite these numerous advantages, polyglycolic (PGA) and poly-L-lactic acid (PLLA) have become a problem because of the potential risk for foreign body reactions. Methods: This article presents a case of an intraosseous foreign body reaction and massive osteolysis of the proximal carpal after dorsal lunate dislocation repair with bioabsorbable suture anchors. Results: Because of the persistent pain and the decreased strength, a proximal row carpectomy was performed 12-months after the initial trauma. Conclusions: Hand surgeons should be aware of the possibility of a late foreign body reaction, that could be especially severe in carpal bones.

Morphology and morphometry of the distal articular surface of lunate bone in a Kenyan population / Morfología y morfometría de la superficie articular distal del hueso semilunar en una población de Kenia

The morphology and morphometry of the distal articular surface of the lunate exhibits inter-population variations. They are of clinical importance to hand surgeons due to their influence on the occurrence of proximal pole arthrosis which is a cause of ulnar-side wrist pain. The objective of the study was to determine the morphology and morphometry of the distal articular surface of the lunate bone in an adult Kenyan population. A descriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi. Fifty-six human hands obtained for routine dissection were used. The morphology of the distal articular surface of the lunate was classified as either Type I or Type II depending on the absence or presence of a medial facet for articulation with the hamate respectively. The width of the wrists and of the medial facet in Type II lunates was measured with SOMETTM CN-25 1234 vernier calipers (accurate to 1mm). Photomacrographs of representative lunate were taken. Data were analyzed using SPSS version 17.0. The Pearson correlation test was used to check for any correlations. Type II lunate morphology was more common with a prevalence of 34 (61 %) while 19 (34 %) were Type I. The mean width of wrists with Type I lunate was 41.1±2.8 mm while those with Type II had a mean width of 46.1±4.3 mm. The mean width of the medial facet in lunate type II was 4.4±1.4 mm. Lunotriquetral fusion was demonstrated in 3 (5 %) wrists. Prevalence of Type II lunate was higher than Type I. Wrists with a Type II lunate were wider than those with Type I. There was no correlation between the width of the wrist and the width of the medial facet of the lunate.

La morfología y morfometría de la superficie articular distal del hueso semilunar muestra variaciones entre la población. Es de importancia clínica para los cirujanos de mano debido a su influencia en la incidencia de la artrosis del polo proximal, que causa dolor ulnar en la muñeca. El objetivo fue determinar la morfología y morfometría de la superficie articular del hueso semilunar en una población adulta de Kenia. Estudio descriptivo de corte transversal, realizado en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se utilizaron 56 manos humanas que fueron sometidas a disección de rutina. La morfología de la superficie articular distal del hueso semilunar se clasificó en Tipo I o Tipo II en función de la ausencia o presencia de una faceta medial de la articulación. El ancho de las muñecas y de la faceta medial en el Tipo II se midió con el caliper SOMETTM CN-25 1234 (precisión de 1 mm). Se tomaron macrofotografías representativas del hueso semilunar. Los datos fueron analizados con el programa SPSS versión 17.0. Se utilizó la prueba de correlación de Pearson. La morfología del hueso semilunar Tipo II fue más frecuente con una prevalencia de 34 casos (61 %), mientras que 19 casos (34 %) eran de Tipo I. El ancho promedio de las muñecas del hueso semilunar Tipo I fue de 41,1±2,8 mm, mientras que las de Tipo II fue de 46,1±4,3 mm. El ancho promedio de la cara medial del hueso semilunar Tipo II fue de 4,4±1,4 mm. Se demostró fusión semilunar-piramidal en 3 casos (5 %). La prevalencia del hueso semilunar Tipo II fue mayor que la del hueso semilunar Tipo I. Las muñecas que presentaban hueso semilunar Tipo II fueron más anchas que las de Tipo I. No hubo correlación entre el ancho de la muñeca y el ancho de la faceta medial del hueso semilunar.

Lesión traumática de la porción proximal del ligamento lunopiramidal como causa de dolor sin inestabilidad articular. Presentación de 2 casos y revisión bibliográfica / Posttraumatic lunotriquetral partial ligament injury as the cause of wrist pain without instability. Two case reports and biblioigraphic review

El dolor postraumático de muñeca continúa siendo hoy un complejo desafío diagnóstico como así también un serio problema clínico en la población joven y laboralmente activa, presentando un alto porcentaje de estos pacientes lesiones ligamentarias inadvertidas de la muñeca. Presentamos 2 casos de lesión parcial del ligamento lunopiramidal postraumática como causa de dolor de muñeca sin inestabilidad, diagnosticados y tratados por vía artroscópica. La remoción artroscópica del colgajo suelto lesionado de la porción membranosa del ligamento lunopiramidal resultó en un alivio de los síntomas. El diagnóstico de esta lesión requiere de un alto índice de sospecha. La RMN sin contraste es de baja sensibilidad para el diagnóstico de las lesiones parciales de los ligamentos interóseos proximales de la muñeca.

Post-traumatic wrist pain remains today a complex diagnostic challenge as well as a serious clinical problem in the young working population, presenting a high percentage of these patients unnoticed wrist ligament injuries. We report 2 cases of posttraumatic lunotriquetral partial ligament injury as the cause of wrist pain without instability, diagnosed and treated arthroscopically. Arthroscopic removal of loose flap injured portion of lunotriquetral membranous ligament resulted in relief of symptoms. The diagnosis of this injury requires a high index of suspicion. MRI without contrast presents low sensitivity for the diagnosis of partial lesions of the proximal interosseous ligaments of the wrist.

Artrodesis mediocarpiana: estudio de la evolución clínico-radiológica con tres años de seguimiento mínimo / Midcarpal fusion. Clinical and radiological study on outcomes with a minimum follow-up of three years

Determinar la evolución clínica y radiológica de los pacientes tratados con artrodesis mediocarpiana con un seguimiento mínimo de tres años. Materiales y Métodos: Se estudiaron los pacientes tratados en nuestro Servicio mediante artrodesis mediocarpiana desde mayo de 1998. Entre un total de 27, se incluyeron 11 muñecas que contaban con un seguimiento mínimo de tres años. Ocho pacientes eran hombres y tres, mujeres, con una media de edad de 47 años (rango 16-66) y un seguimiento promedio de 6.7 años (rango 3-15). La técnica utilizada fue artrodesis de 2 o 4 esquinas con resección del escafoides más injerto de radio distal. Se evaluaron el dolor con la Escala Analógica Visual, la movilidad y la fuerza de puño. Se aplicó el cuestionario QuickDASH y se tomaron radiografías de control. Resultados: El dolor mejoró de 5/10 en reposo y 8/10 en actividad antes del procedimiento a 0/10 y 2/10, respectivamente. La movilidad perdida con respecto al lado sano fue del 39% de flexo-extensión, 15% de desviación radial y 31% de desviación cubital. No hubo cambios en la pronosupinación y el QuickDASH posoperatorio fue de 10. La fuerza fue del 92% comparada con el lado contralateral. Radiológicamente cuatro pacientes no tuvieron cambios en la luz articular radiolunar; en los restantes, disminuyó. Dos fueron reoperados por seudoartrosis, con injerto óseo. Conclusiones: La artrodesis mediocarpiana mejora los síntomas y conserva el 61% de la flexo-extensión, el 85% de la desviación radial, el 31% de la cubital y el 92% de la fuerza. Nivel de Evidencia: IV...

To determine the clinical and radiological outcomes of patients treated with midcarpal arthrodesis with a minimum follow-up of three years. Methods: Patients treated in our Service through midcarpal arthrodesis since May 1998 were studied. From a total of 27 patients, 11 wrists with a minimum follow-up of 3 years were included. Eight patients were men and three were women, with a mean age of 47 years (range 16-66) and an average follow-up of 6.7 years (range 3-15). The technique was 2 or 4 corner fusion with scaphoid resection plus distal radius graft. Pain using Visual Analog Scale, mobility, and grip strength were evaluated. QuickDASH scoring and control X-rays were performed. Results: Pain improved from a preoperative value of 5/10 at rest and 8/10 at activity to 0/10 and 2/10 after surgery, respectively. The lost motion with respect to the healthy side was flexo-extension 39%, radial deviation 15%, and ulnar deviation 31%. There were no changes in pronosupination and the postoperative QuickDASH score was 10. Force was 92% compared to the opposite side. Radiologically four patients didn´t show changes in radiolunate joint space; in the remaining, it was narrower. Two patients were reoperated on for nonunion with bone graft. Conclusions: Midcarpal fusion improves symptoms, retaining 61% of flexo-extension, 85% of the radial deviation, 31% of the ulnar deviation and 92% of the force. Level of Evidence: IV...

[Intra-articular distal radial fracture with lunate fossa rotated, about 4 cases: interest of surgical procedure by volar medial approach]. / Fracture articulaire du radius distal avec fragment de fossette lunarienne retourné, à propos de 4 cas : intérêt du traitement chirurgical par voie antéro-médiale.

INTRODUCTION: Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. MATERIAL AND METHODS: Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone's classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator. RESULTS: The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O'Brien's criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter's classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3. DISCUSSION AND CONCLUSION: Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.

Osteotomy of the radius without shortening for Kienböck disease: a 10-year follow-up.

PURPOSE: To determine the long-term effect of distal radius osteotomy without modifying the radial length or inclination for Kienböck disease. METHODS: Over 9 years, 14 patients underwent osteotomy of the distal radius without altering radial length or inclination. A total of 11 of these patients were available for follow-up after 10 or more years. We assessed pain, range of wrist motion, and grip strength preoperatively and postoperatively in all cases, as well as preoperative and postoperative posteroanterior and lateral x-rays. RESULTS: The osteotomy healed in all cases. All 11 patients had decreased pain and showed improvement in wrist motion and grip strength. Radiographically, there were no measurable changes in ulnar variance and there was minimal loss of carpal height. In some patients, the lunate showed increased sclerosis or fragmentation. CONCLUSIONS: An osteotomy of the distal radius without altering radial length or inclination was effective in decreasing pain and improving grip strength and wrist motion regardless of ulnar variance.