Radial and ulnar shortening osteotomy as a potential treatment for ulnar-positive Kienböck disease

Purpose: Radial shortening osteotomy (RSO) is an effective treatment for Kienböck disease, but it can be challenging to perform in patients with positive ulnar variance because of the risk of ulnar impaction. This study evaluated the radiographic outcomes of patients with positive ulnar variance who underwent both ulnar shortening osteotomy (USO) and RSO for Kienböck disease and compared these outcomes with those of patients who underwent RSO alone.Methods: This retrospective study included 17 patients who underwent surgery at a tertiary hospital between 2016 and 2024. Seven patients with positive ulnar variance underwent both RSO and USO, whereas 10 patients with negative or neutral ulnar variance underwent RSO alone. All patients had Lichtman stage II or III disease. Preoperative and postoperative staging was performed, and lunate collapse was evaluated using plain radiography.Results: In the RSO-only group, disease progression was observed in three of 10 patients (30%) based on the Lichtman staging system. In the combined RSO and USO group, one of seven patients (14%) showed disease progression, one (14%) showed improvement, and the remaining five patients (71%) showed no change in stage. Additionally, one patient (14%) in the combined group demonstrated complete resolution of fragmentation on magnetic resonance imaging. Radiographically, no significant postoperative lunate collapse was observed in any patient.Conclusion: In patients with ulnar-positive Kienböck disease, adding USO to RSO did not adversely affect radiographic outcomes compared with RSO alone, despite the potential reduction in the joint-leveling effect. Further studies are needed to evaluate changes in mechanical loading and regional blood flow after combined osteotomy.