Optimizing Wedge Osteotomy for Load Reduction on Lunate Bone in Kienböck's Disease: Findings and Recommendations of a Biomechanical Study

Abstract Conflicting results in biomechanical studies on radial osteotomies highlight the value of simulation studies in understanding the mechanisms and factors affecting the success of radial wedge osteotomy. This biomechanical study aimed to determine the efficacy of various radial wedge osteotomies in subjects with Kienbock's disease based on three-dimensional (3D) modeling. Computed tomography scan images of a normal wrist joint were used to generate a 3D model of the wrist joint. Various simulated radial open wedge osteotomies, including medial and lateral procedures, different osteotomy lengths, and osteotomy angles, were evaluated. The stress exerted on the lunate bone in the radio-lunate and lunate-capitate joints was determined under each of these conditions. The location of the radial wedge osteotomy significantly influenced the loads applied to the lunate bone during wrist motion, with the preferred method being 1 inch proximal to the wrist joint axis. The degree of wedge osteotomy also had an impact, with a 10-degree wedge osteotomy being preferred. Additionally, the site of osteotomy appeared to be important, with lateral opening being superior to lateral closing. Wedge osteotomy is recommended as a preferred method for reducing stress on the lunate bone. It is recommended to perform the osteotomy 1 inch proximal to the wrist joint with a 10-degree angle and utilizing a lateral opening technique. V.