Abstract
Introduction: We report on our experience of using a vascularised bone graft harvested from the volar face of the radius in the treatment of Kienböck’s disease, with an average follow up of 79 months and a minimum of 5 years.
Materials: We treated 22 patients with Kienböck’s disease. There were 8 women and 14 men whose average age was 31.4 years old (range 18–63 years). Pain was always present and incapacitating in 19 cases. All patients underwent pre-operative tomodensitometry and an MRI, based on LICHTMAN’s classification there were 8 stage II, 10 stage IIIA and 4 stage IIIB.
Methods: The volar carpal artery of the carpus originates from the radial artery and vascularises medial part of the radial epiphysis. Using the same anterior surgical approach it was possible to harvest the pedicled bone graft from this artery and to place it into the lunate for revascularisation. Shortening of the radius was carried out in all cases, as was immobilisation until union of the radius.
Results: Our average follow up is 79 months (range 60–138 months). Pain disappeared completely in 20 cases, and was moderate and tolerable in 2 cases. The average active range of motion was higher than 71°. The average period for return to work was 3.5 months. Post-operative MRI at an average of more than 8 months showed 16 complete revascularisations of the lunate, 5 stabilizations of lesions and one failure which necessitated secondary palliative treatment. There were 4 delayed unions of the radius and one Südeck’s dystrophy. There was a clear correlation between the stage of Kienböck’s disease and the final outcome of surgery.
Discussion: The use of a vascularised bone graft harvested from the anterior face of the radius for the revascularisation of the lunate associated with shortening of the radius has given encouraging results. A longer-term study is necessary.
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