Jnl Wrist Surg 2019; 08(03): 226-233
DOI: 10.1055/s-0039-1683931
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Kienböck's Disease Treated by Camembert Osteotomy at Seven Years

Emmanuel J. Camus
1  SELARL Chirurgie de la Main, Clinique Du Val de Sambre, Maubeuge, France
2  ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
,
Luc Van Overstraeten
2  ULB Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
3  Hand Foot Surgery Unit, Tournai, Belgium
› Author Affiliations
Further Information

Publication History

26 November 2018

04 February 2019

Publication Date:
25 March 2019 (eFirst)

Abstract

In Kienböck's disease, radius shortening osteotomy is the most common treatment. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical symptoms and limits lunate collapse. The series include 10 patients who underwent a Camembert osteotomy for Kienböck's disease between 2002 and 2012 (one bilaterally). They are six men and four women, aged 40.6 years. Five patients had an additional ulnar shortening osteotomy if ulnar variance was neutral or positive. The mean follow-up is 7 years. Preoperatively, range of motion, grip strength, pain, and functional scores were poor. All osteotomies healed within 3 months. Extension, ulnar deviation, grip, functional scores improved significantly. In 10 cases, there were improvement in the T1 and T2 signals on the magnetic resonance imaging (MRI). There was no lunate collapse. This series shows good results with no worsening of the lunate shape. There was no ulnocarpal impingement. The Camembert osteotomy proposes to offload the lunate and redirect strains toward the scaphoid. The supposed interest is to protect the lunate from collapse. In this small series, the Camembert osteotomy improved function in patients with early stage Kienböck's disease. MRI aspects improve in most cases and no patients collapsed. Camembert can be used in combination with a Sennwald's ulnar shortening when ulnar variance is neutral or positive. Authors propose this procedure for Lichtman's stages 1–2–3A if there are no cartilage or ligament lesions. This is a Level IV, case series study.