Biomechanical evaluation of operative procedures to treat Kienböck's disease.

Operative procedures used to treat Kienböck's disease have been biomechanically evaluated experimentally. We have shown that joint leveling procedures, such as radial shortening and ulnar lengthening, experimentally unload the ulna and the radial lunate fossa. For wrists with neutral ulnar variance, a lateral opening or medial closing radial wedge procedure unloads the radial lunate fossa. Scapho-trapezio-trapezoidal fusion and scapho-capitate fusion also unload the radial lunate fossa but at the expense of loading the adjacent joints. Neither a capitate-hamate fusion nor a carpal tunnel release alter the radial ulnar carpal joint loading.