Kienbock's disease (lunate avascular necrosis) in a patient with negative ulnar variance (ulna shorter than radius) and Stage II disease (sclerosis, no collapse) is best managed by:

• A Radial shortening osteotomy to equalize ulnar variance ✓
• B Proximal row carpectomy
• C Wrist arthrodesis
• D Silastic lunate implant

Explanation

In Kienbock's disease with negative ulnar variance (short ulna), a radial shortening osteotomy (typically 2–3 mm) equalizes the radiocarpal and ulnocarpal load, reducing compressive forces on the lunate and allowing revascularization. This is the procedure of choice for Stages I–IIIa. Proximal row carpectomy and wrist arthrodesis are salvage procedures for advanced stages. Silastic implants are associated with silicone synovitis and poor long-term results. Ulnar lengthening achieves the same mechanical goal.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.