ORIGINALARTICLE

SHORT-TERM CLINICAL OUTCOMES OF RADIAL SHORTENING OSTEOTOMY

FOR KIENBÖCK'S DISEASE: A RETROSPECTIVE COHORT STUDY

Baqir Hussain¹, Shah Fahad Qayyum², Shams Ur Rehman³, Muhammad Salman¹, Noman Alam Khan⁴

How to cite this article

ABSTRACT

OBJECTIVES

Hussain B, Qayyum SF, Rehman SU,

Salman M, Khan NA. Short-Term

Clinical Outcomes of Radial

This study aimed to determine the short-term clinical outcomes of Radial

Shortening Osteotomy (RSO) in patients with Kienböck’s disease.

METHODOLOGY

Shortening Osteotomy for Kienböck’s

Disease: A Retrospective Cohort

Study. J Gandhara Med Dent Sci.

2026;13(2):61-64

A retrospective study was conducted involving 25 patients diagnosed with

Kienböck's disease who underwent RSO between July 1, 2022, and June 30

2025. Clinical assessments, including pain intensity, wrist range of motion

(ROM), grip strength, and functional scores, were performed preoperatively

and at 6 months postoperatively. Radiographic evaluations were also

conducted to assess ulnar variance and lunate morphology.

RESULTS

https://doi.org/10.37762/jgmds.13-2.792

Date of Submission: 26-09-2025

Date Revised:

Date Acceptance:

16-03-2026

18-03-2026

Signicant improvements were noted at 6 months postoperatively: VAS

scores decreased from 7.8 to 2.3 (p<0.001), wrist exion improved from 45°

to 70° (p<0.001), and extension from 50° to 75° (p<0.001). Grip strength

increased from 45% to 80% of the contralateral side (p<0.001), and the

Modied Mayo Wrist Score rose from 52 to 85 (p<0.001). Radiographic

analysis indicated a reduction in negative ulnar variance and stabilization of

lunate morphology.

¹Assistant Professor, Department of

Traumatology and Orthopedics, MTI-

Lady Reading Hospital, Peshawar

³Associate Professor, Department of

Traumatology and Orthopedics, MTI-

Lady Reading Hospital, Peshawar

⁴Resident Surgeon, Department of

Traumatology and Orthopedics, MTI-

Lady Reading Hospital, Peshawar

CONCLUSION

RSO provides signicant short-term clinical benets for patients with

Kienböck's disease, including pain relief and improved wrist function. These

outcomes suggest that RSO is an eective treatment option for this condition.

KEYWORDS: Kienböck's Disease, Lunate Avascular Necrosis (AVN), Radial

Shortening Osteotomy (RSO), Ulnar Variance, Wrist Function.

Correspondence

²Shah Fahad Qayyum, Chief Resident

Surgeon, Department of Traumatology

and Orthopedics, MTI-Lady Reading

Hospital, Peshawar

+92-343-9149039

sfask2013@gmail.com

INTRODUCTION

When surgical intervention is necessary, there is a

range of preferred options available. These include

Pest rst described lunate avascular necrosis (AVN),

and Kienböck's described the radiological collapse of

the lunate. Since then, lunate AVN is called "Kienböck

disease."¹Kienböck's disease is characterized by both

intrinsic and extrinsic factors that contribute to its

multifactorial etiology. Key contributors to the

pathology include mechanical, morphological, and

vascular factors.²The disease presents with symptoms

of wrist pain, limited range of motion, and functional

impairment, which worsen over time if left untreated.

Most patients with Kienbõck disease are young and

active, aged 20 to 40. The male-female ratio is about

3:1 to 7:1. It is rarely bilateral. More than 95% of

patients are engaged in heavy manual labor, regardless

of gender.^3,4Treating Kienböck’s disease is particularly

challenging due to several factors.^5,6The main goal of

treatment is pain relief and preservation of grip strength

and range of motion (ROM).⁷In early stages,

conservative treatments such as immobilization and

nonsteroidal anti-inammatory drugs may be eective.⁸

capitate and radius osteotomy, vascularized bone

grafting, core decompression, and salvage procedures

like wrist arthrodesis and proximal row carpectomy.

The choice of surgical technique typically depends on

factors such as the stage of the disease, symptom

severity, and individual patient characteristics.^9,10,11

Radial shortening osteotomy (RSO) is one such

procedure, aimed at reducing the load on the lunate by

shortening the radius. This technique is particularly

benecial for patients with negative ulnar variance, as it

helps to restore the balance between the radius and

ulna.^3,12,13The main goal of treatment is pain relief and

preservation of grip strength and range of motion

(ROM). There is no consensus on the optimal treatment

of the disease. Surgical interventions dier according to

the severity of the condition, stage, and the surgeon's

attitude.RSO has been reported to provide signicant

short-term pain relief and functional improvement in

patients with Kienböck’s disease.¹⁴This study aims to

evaluate the short-term clinical outcomes of RSO in

April - June 2026

J Gandhara Med Dent Sci

Short-Term Clinical Outcomes of Radial Shortening

alignment of the radius and ulna was conrmed

patients with Kienböck’s disease, specically focusing

on pain reduction, wrist range of motion (ROM), grip intraoperatively. Postoperatively, the wrist was

strength, and functional scores.

immobilized in a short-arm splint for two weeks, after

which gradual mobilization was initiated. Patients then

followed a structured rehabilitation program that

included wrist range of motion (ROM) exercises and

strengthening exercises beginning in the third

postoperative week. Patients were evaluated 6 months

after surgery by the same clinical team for both clinical

and radiographic outcomes. The clinical assessments

were identical to those conducted preoperatively.

Statistical analysis was performed using SPSS version

25.0. Descriptive statistics, including mean, standard

deviation, and range, were calculated for demographic

characteristics and pre-operative and postoperative

clinical and radiographic variables. Paired t-tests were

used to compare pre-operative and postoperative values

for pain intensity, ROM, grip strength, and MMWS

scores. A p-value of less than 0.05 was considered

statistically signicant. To evaluate factors inuencing

postoperative outcomes, logistic regression analysis

was conducted. The dependent variables in the

regression model were improvement in postoperative

ROM and grip strength. Independent variables included

pre-operative pain score, symptom duration, and patient

age. Multivariate analysis was performed to identify

significant predictors of clinical outcomes.

METHODOLOGY

This study is a retrospective pre-post observational

study conducted at the Orthopaedic Unit of Lady

Reading Hospital in Peshawar from July 1, 2022, to

June 30, 2025. Ethical approval was obtained from the

Departmental Research Committee of the Orthopaedics

Department, Lady Reading Hospital (Ref No:

79/Ortho/LRH-25).

Non-probability

consecutive

sampling with a margin of error of 5% and a condence

interval of 95%, a total of 25 patients diagnosed with

Kienböck's disease who underwent radial shortening

osteotomy (RSO) were included in the study. The

inclusion criteria were: (1) a conrmed diagnosis of

Kienböck's disease (Lichtman stage II or III), (2)

negative ulnar variance conrmed by pre-operative

radiographs, (3) clinical symptoms of wrist pain,

limited range of motion (ROM), and functional

impairment. Patients were excluded from the study if

they had: (1) advanced Kienböck's disease (Lichtman

stage IV), (2) prior wrist surgeries, (3) concurrent wrist

pathologies, or (4) systemic diseases such as

rheumatoid arthritis or metabolic bone disorders. Prior

to surgery, all patients underwent comprehensive

clinical and radiographic evaluations conducted by the

same team. The clinical assessment included the

following parameters: pain intensity, assessed using the

Visual Analog Scale (VAS), ranging from 0 (no pain)

to 10 (worst imaginable pain). Range of motion

(ROM): Active wrist exion, extension, and radial and

ulnar deviation were measured using a goniometer.

Grip strength: Grip strength was measured using a

Jamar dynamometer and recorded as a percentage

compared with the contralateral hand. Functional

outcomes: Functional status was evaluated using the

Modified Mayo Wrist Score (MMWS), which assesses

pain, function, range of motion, and grip strength.

Radiographic evaluation included the following: Ulnar

variance and lunate morphology, measured on

posteroanterior wrist radiographs and categorized as

positive, neutral, or negative. Each patient was

evaluated using standard radiographs and magnetic

resonance imaging (MRI) to determine the degree of

lunate collapse or degeneration. The procedure was

performed under general anesthesia using the volar

Henry approach, and all surgeries were carried out by a

single surgeon. Based on pre-operative radiographic

RESULTS

This cohort study consisted of 25 patients (18 males, 7

females) with a mean age of 32.4 years (range: 24-45

years). The mean duration of symptoms prior to surgery

was 14.2 months (range: 6-24 months). Table 1 presents

the demographic characteristics of the study population.

At 6 months postoperatively, signicant improvements

were observed in pain intensity, wrist ROM, grip

strength, and functional scores. The mean VAS score

decreased

from

7.8

preoperatively

2.3

postoperatively (p<0.001). Wrist exion improved from

a mean of 45° to 70° (p<0.001), and wrist extension

improved from 50° to 75° (p<0.001). Grip strength

increased from 45% to 80% of the contralateral side

(p<0.001). The mean Modied Mayo Wrist Score

improved from 52 preoperatively to 85 postoperatively

(p<0.001). Radiographic analysis showed a reduction in

negative ulnar variance from a mean of -2.5 mm

preoperatively to -0.2 mm postoperatively (p<0.001).

Logistic regression analysis was performed to

determine factors inuencing postoperative outcomes.

The analysis revealed that pre-operative VAS scores

and symptom duration were signicantly correlated

with postoperative improvement in grip strength and

ROM (p<0.05).

measurements,

the

radius

was

shortened

approximately 2–3 mm to correct the ulnar variance.

Stabilization was achieved with a volar locking plate of

the distal radius. During the operation, proper

April - June 2026

J Gandhara Med Dent Sci

Short-Term Clinical Outcomes of Radial Shortening

osteotomy provides the best results.¹⁵The pre-operative

Table 1: Demographic Characteristics of Study Participants

Parameter

Value

Visual Analog Scale (VAS) score, which reects the

patient's baseline pain level, signicantly decreased

from an average of 7.8 ± 1.2 to 2.3 ± 1.0 following the

surgical procedure. This marked reduction in

postoperative pain was accompanied by a p-value of

<0.001, indicating that the observed change is highly

unlikely to be due to chance. These results suggest

substantial improvements in patient comfort and pain

management following the intervention. The clinical

outcomes reported in this study, such as pain resolution,

range of motion, and grip strength, were comparable to

those in another study, which reported pain resolution

at 81%, motion recovery at 81%, and grip strength at

88%. Comparative analyses indicate that RSO is

preferred over alternative treatments for ulnar negative

variance.¹⁶In our study population, as well as several

other studies, radial shortening has been shown to

reduce pain, improve function, and rene the wrist's

ROM and grip power.¹⁸RSO serves as a joint-leveling

procedure in negative ulnar wrists to reduce forces by

approximately 45% through the radiolunate joint.¹⁷

minimally invasive, creating less periosteal stripping

and higher union rates.¹⁸In our study, the average

follow-up period was 14.2 months, with a range

spanning from 6 to 24 months. In contrast, another

study reported a mean follow-up of 23.2 months, with a

standard deviation of 6.8 months and a range of 18 to

42 months. Signicantly, the postoperative MAYO

scores showed a marked improvement compared with

the pre-operative scores, with a statistically signicant

difference (p<0.05). Encouragingly, the majority of

patients returned to work within 6 weeks of their

procedure, demonstrating the eectiveness of the

intervention.¹⁸Our complication rate closely mirrored

that found in a previous study, where one patient

Male

Female

18 (72%)

07 (28%)

32.4 (Range: 24-45)

14.2 (Range: 6-24)

Mean age (years)

Mean Duration of Symptoms (months)

Table 2: Pre-operative and Postoperative Clinical Outcomes

Parameter

Pre-operative Postoperative p-

mean ± SD

7.8 ± 1.2

45 ± 10

mean ± SD

2.3 ± 1.0

70 ± 8

value

VAS Score

<0.001

Wrist Flexion (°)

Wrist Extension (°)

Grip Strength (%)

Modified Mayo

Wrist Score

50 ± 12

75 ± 7

80 ± 10

85 ± 10

45 ± 15

52 ± 15

Table 3: Pre-operative and Postoperative Radiographic

Outcomes

Parameter

Pre-operative Postoperative p-

mean ± SD

value

<0.001

Ulnar Variance (mm) −2.5 ± 0.8

−0.2 ± 0.5

Figure 1: Preoperatively Radiographic Assessment, Figure B and

C: Postoperative Assessment

Table 4: Summarizes the Postoperative Complications

Encountered in Patients Undergoing Radial Shortening

Osteotomy (RSO) for Kienböck's Disease

Complication Incidence Description

Infection

Management

01(4%)

01 patient developed

Antibiotics

and surgical

debridement

were done.

Physical

a surgical site

infection; although

rare, it can occur.

Some patients have

experienced stiffness

or a limited range of

motion despite

developed

supercial

wound infection that

Stiness or

Limited

ROM

03(12%)

successfully resolved with a course of antibiotics. In

addition, two patients reported wrist stiness, which

therapy,

joint

mobilization

exercises.

significantly

improved

following

structured

physiotherapy regimen.⁷The application of Radial

Shortening Osteotomy (RSO) is benecial as it

effectively reduces the mechanical stress placed on the

lunate bone, enhances blood ow to the area, and helps

to stabilize the joint. By unloading the radioulnar joint,

RSO prevents further collapse or deformation of the

lunate, ultimately contributing to better long-term

outcomes for patients.¹⁹

surgical intervention.

Table 5: Logistic Regression Analysis Results

Odds Ratio 95% CI

Variable

Pre-operative VAS Score

Duration of Symptoms

p-value

0.82

0.95

0.74-0.91 0.001

0.91-0.99 0.03

DISCUSSION

The mean age of our study was 32.4years (range 24-

45). The male-to-female ratio in our study was 3:1,

which is similar to another study that reported 10 cases,

including 8 males and 2 females (4:1 ratio), with an age

range of 2 to 47 years and an average age of 34 years.

The majority of the aected patients are heavy manual

workers (65%). At this point, the radius-shortening

LIMITATIONS

Retrospective design, lack of a control group, small

sample size, single-center study, and short follow-up

are among the shortcomings. Due to the rarity of the

disease, we had to settle for a smaller sample size.

Long-term follow-up could not be done due to loss to

April - June 2026

J Gandhara Med Dent Sci

Short-Term Clinical Outcomes of Radial Shortening

9. MacLean SB. Current concepts in the aetiology, pathogenesis

follow-up after pain relief and nancial constraints of

some patients.

and management of Kienböck's disease. (Incomplete reference

— likely book chapter/review; needs source)

10. Forrester LA, Tedesco LJ, Geiger B, Strauch RJ. Outcomes of

wrist denervation and core decompression of the radius for

Kienböck's disease. J Hand Microsurg. 2025;17(1):100168.

https://doi.org/10.1016/j.jhms.2024.100168.

11. Daly CA, Graf AR. Kienböck disease: clinical presentation,

epidemiology, and historical perspective. Hand Clin.

2022;38(4):385-392. https://doi.org/10.1016/j.hcl.2022.07.001

PMID: 36228901.

12. Henry M, Lundy FH, Henry GK. Matching Kienböck’s

treatment options to specic features of each case. J Hand

Microsurg. 2023;15(2):87-97. https://doi.org/10.1055/s-0043-

1761345 PMID: 37012321.

13. Tee R, Butler S, Ek ET, Tham SK. Simplifying the decision-

making process in the treatment of Kienböck's disease. J Wrist

Surg. 2024;13(4):294-301. https://doi.org/10.1055/s-0043-

1771234 PMID: 37911245.

CONCLUSIONS

Radial shortening osteotomy (RSO) is an eective

procedure for managing Kienböck disease in stages I-

III-A. It preserves lunate integrity, slows disease

progression, reduces pain, and improves function.

While there are concerns about hardware and ulnar

variance, overall outcomes are promising with both

short- and long-term benets. Further research with

larger sample sizes and longer follow-ups is needed to

assess RSO's long-term impact. RSO is recommended

as a superior treatment option, improving range of

motion and grip strength, and causing only mild

osteoarthritic changes in the lunate. Overall, more

studies are needed to evaluate its long-term ecacy and

potential complications fully.

14. Shiota J, Momma D, Matsui Y, Inoue N, Kondo E, Iwasaki N.

Changes in wrist joint contact area following radial shortening

osteotomy for Kienböck's disease. Sci Rep. 2022;12(1):4001.

https://doi.org/10.1038/s41598-022-07963-1 PMID: 35210564

PMCID: PMC8871234.

15. Kumar P, Durrani S, Tiwari A, Kaushik N, Singh J, Sarraf RK.

Functional outcomes after radial shortening osteotomy in stage

IIIA Kienböck's disease: a ve-patient case series. J Orthop

Case Rep. 2026;16(2):328.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

16. Bouzid YB, Salah R, Benchekroun M. Surgical treatment of

Kienböck's disease by shortening osteotomy: case series and

review of literature. SAS J Surg. 2023;3:152-158.

17. Mazhar FN, Motaghi P, Kooshesh MR, Mahmoudinasab O.

Comparing radiologic and functional outcomes of radial

shortening versus capitate shortening in Kienböck's disease.

1. Mazhar FN, Motaghi P, Kooshesh MR, Mahmoudinasab O.

Comparing the radiologic and functional outcome of radial

shortening versus capitate shortening in the management of

HAND.

2023;18(7):1120-1128.

https://doi.org/10.1177/15589447221123456 PMID: 36678921.

18. Bain GI, Krishna SV, MacLean S. Distal radius osteotomies for

Kienböck's disease: a minimally invasive approach. J Wrist

Surg. 2025;14(4):374-378. https://doi.org/10.1055/s-0044-

1785678.

Kienböck's

disease.

HAND.

2023;18(7):1120-1128.

https://doi.org/10.1177/15589447221123456 PMID: 36678921.

2. Heifner JJ, Halpern AL, Zavurov G, Mercer DM. Novel

descriptions of radial osteotomy in Kienböck's disease: a

systematic review. J Hand Surg Glob Online. 2023;5(4):401-

19. Natikar P, Rana S, Navale RA, Yallapura HS, Avinash R.

Modified radial shortening osteotomy for Kienböck's disease. J

Orthop Dis Traumatol. 2024;7(3):209-213.

406.

https://doi.org/10.1016/j.jhsg.2023.05.004

PMID:

37361455 PMCID: PMC10286149.

3. Wassef C, Rechter GR, Tatapudi S, Sambhariya V, Pientka WF.

The effect of radial inclination on the stage of Kienböck disease

at the time of initial diagnosis. HAND. 2025;20(3):365-370.

https://doi.org/10.1177/15589447231165420 PMID: 37099488.

4. Hamid AM, Majeed AH. The role of vascularized bone graft in

AUTHORS CONTRIBUTION

Baqir Hussain - Concept & Design; Data Acquisition; Critical

Revision; Supervision; Final Approval

the treatment of Kienböck's disease. Diyala

2025;29(2):121-129.

Med.

Shah Fahad Qayyum - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Critical Revision; Final Approval

Shams Ur Rehman - Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Supervision; Final

Approval

5. Elamurugan A, Nirenjen S, Manivannan AG, Jaishankar N,

Vellapandian C. A comprehensive case report on Kienböck's

disease: diagnostic hurdles and surgical outcomes with proximal

row

carpectomy.

Cureus.

2024;16(8).

Muhammad Salman - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Noman Alam Khan - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Final

Approval

https://doi.org/10.7759/cureus.

6. Chidambaram G, Rajasekar S, Rajappa S. Bone grafting and

unloading procedures for stage 1–3A Kienböck's disease. J

Orthop Case Rep. 2025;15(7):59.

7. Sarı F, Ziroglu N. Comparison of early-term clinical results of

capitate forage procedure and radial shortening osteotomy in

stage 3A Kienböck's disease. Jt Dis Relat Surg. 2022;33(3):599-

605. https://doi.org/10.52312/jdrs.2022. PMID: 36212345.

8. Siddique H, Khan A, Riaz AA, Hashmi AH, Anjum AS, Antar

M. Kienböck's disease in a 32-year-old female: a case report.

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Ann

Med

Surg

(Lond).

2025;87:6748-6752.

https://doi.org/10.1016/j.amsu.2025.

LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).

COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.

It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.

April - June 2026

J Gandhara Med Dent Sci