Radial Shortening Osteotomy in Kienbock Disease: A Case Series, Single Surgeon Experience

Abstract Background: Kienbock disease is a debilitating condition characterized by progressive osteonecrosis of the lunate bone in the wrist. The lunate, a small carpal bone critical to wrist biomechanics, is vulnerable to avascular necrosis due to its limited blood supply. The condition is frequently associated with negative ulnar variance, a morphological variant in which the ulna is shorter than the radius relative to the wrist joint. This anatomical configuration alters load distribution across the radiocarpal joint, placing disproportionate mechanical stress on the lunate, which contributes to its vascular compromise and subsequent collapse. Objective: To evaluate the clinical and radiological outcomes of radial shortening osteotomy in patients diagnosed with Lichtman Stage II to IIIb Kienbock disease in the presence of negative ulnar variance. Materials and Methods: A prospective case series of nine patients with Lichtman Stage II–IIIb Kienbock disease who were managed surgically with radial shortening osteotomy was conducted at our institution. Inclusion criteria required a confirmed negative ulnar variance on preoperative imaging and the absence of advanced carpal collapse. Clinical evaluation encompassed pain assessment using a visual analogue scale, wrist range of motion measured goniometrically, grip strength recorded via dynamometry, and validated functional outcome scores. Radiological assessment was performed using serial plain wrist radiographs at standardized postoperative intervals. The mean follow-up duration was 18 months. Results: All nine patients demonstrated meaningful postoperative pain relief, with significant reductions in visual analogue scale scores compared to preoperative baselines. Wrist range of motion and functional scores showed consistent improvement across the cohort. Grip strength recovered to an average of 80% of the contralateral side. Radiological evaluation demonstrated stabilization of lunate collapse in the majority of cases, with no patient exhibiting progressive carpal deterioration during the follow-up period. No major intraoperative or postoperative complications were recorded. Conclusion: Radial shortening osteotomy is an effective joint-preserving surgical intervention for Lichtman Stage II–IIIb Kienbock disease in patients with negative ulnar variance. By redistributing mechanical load away from the compromised lunate, the procedure reliably achieves pain relief, functional improvement, and radiological stabilization. These findings support its use as a primary surgical option in appropriately selected patients, intending to halt disease progression and preserve long-term wrist function.