P. Ducarmois’s research while affiliated with Clinique Notre-Dame de Grâce de Gosselies and other places

L'analyse d'une série de neuf cas montre que l'allongement du cubitus dans la maladie de Kienböck a donné satisfaction à l'ensemble des patients avec un recul de plus de 20 ans surtout au point de vue de la douleur et de la force, alors que la mobilité s'est même encore détériorée. Sans pour autant avoir pu rendre une morphologie normale au semi-lunaire, cette technique s'est montrée capable d'enrayer durablement l'évolution naturelle de la maladie vers le collapsus et l'arthrose du carpe sans induire de désaxation radio-carpienne. Cependant, des délais trop longs de consolidation et un taux élevé de pseudarthrose sont à déplorer. La variance cubitale ne semble pas être un facteur étiologique. L'impact de l'intervention sur la RCI et la survenue du syndrome d'impaction cubitale dans les allongements excessifs restent des points inquiétants à surveiller même s'il n'a pas été constaté de conséquences cliniques à long terme. Aussi, il semble préférable de ne proposer cette intervention que chez des patients jeunes, au stade débutant de la maladie présentant un index RCI négatif. Pour ce faire, il est fortement recommandé de suivre la technique opératoire de Linscheid.

The treatment of Kienböck's disease is currently controversial. Ulnar shortness is usually considered to be the main etiological factor. This observation is the basis for distal radio-ulnar joint levelling procedures, which means the radial shortening osteotomy and ulnar lengthening osteotomy. Several authors have reported their experience on the topic, but there are very few studies with sufficient follow-up to evaluate the value of the operative procedure on the carpus. We report a 9 patient review series following an ulnar lengthening procedure for Kienböck's disease. The average follow-up was 24 years (range: 12 to 21 years). There were 7 men and 2 women and the average age was 30 years at the time of the operation. The dominant side was affected 6 times out of 9.6 heavy workers and 3 light workers are reported. Four out of 9 patients had a history of trauma. The surgical procedure was a stair-step distal diaphyseal ulnar lengthening with distraction and osteosynthesis with a plate, without bone graft. The selected patients underwent a clinical examination of wrist pain, mobility and strength in comparison with the non-operated side. All patients under went a standard radiographical examination in neutral position. The analysis of the series shows that ulnar lengthening was successful for all patients especially on the strength and pain level, whereas mobility deteriorated. Without being able to reconstitute the normal morphology of the lunate bone, the procedure was able to stop the long-term natural course of the disease leading to carpus collapse and arthrosis without radio-carpal disturbance. Excessively long consolidation times and a very high pseudarthrosis rate are reported. Ulnar shortness does not seem to be an etiological factor. The natural history of the disease is perhaps not as bad as previously thought. The impact of the procedure on the distal radio-ulnar joint and the ulnar impaction syndrome in excessive lengthening are serious issues which need to be resolved. The procedure is preferably indicated in young patients, at the beginning of the disease, with a negative distal radio-ulnar variance. The Linscheid operative technique is recommended.