The use of the 4 + 5 extensor compartmental vascularized bone graft for the treatment of Kienböck’s disease

Purpose

The use of vascularized bone grafts for the treatment of Kienböck’s disease may prevent ongoing lunate collapse and provide relief of wrist symptomatology. This study examines our experience with the use of the 4 + 5 extensor compartmental artery (ECA) bone graft for the treatment of Kienböck’s disease.

Methods

A retrospective review was performed of all patients having pedicled vascularized bone grafts for Kienböck’s disease between 1991 and 2002. Only those patients who had reconstruction with a 4 + 5 ECA graft were included in the study. Presurgical and postsurgical measurements included range of motion, grip strength, and pain evaluation. Measurements of the radiolunate angle, radioscaphoid angle, Ståhl’s index, and carpal height ratio were taken from presurgical and final follow-up radiographs. Postsurgical magnetic resonance imaging scans were also examined to verify revascularization of the lunate. Statistical analysis was performed using Student’s t test. A chi-square test was used to evaluate the effects of lunate revascularization on radiographic progression of disease. Twenty-six 4 + 5 ECA vascularized bone grafts were performed as treatment for Kienböck’s disease. The average patient age was 32 years. At the time of surgery 12 patients were graded as stage II, 10 as IIIA, and 4 as IIIB. Mean follow-up time was 31 months.

Results

At a mean follow-up of 3 months, motion improved from 68% to 71% of the unaffected side, grip strength improved from 50% to 89% of the unaffected side, and 92% of patients had significant improvement in their pain. Satisfactory results were seen in 85% of patients based on the Lichtman outcome score. Seventy-seven percent of patients showed no further collapse on postsurgical radiographs. Sixty-five percent of patients had follow-up magnetic resonance imaging scans at a mean of 20 months after surgery. Seventy-one percent of patients showed evidence of revascularization with improvement in the T2 and/or T1 signal.

Conclusions

The 4 + 5 ECA bone graft provides a reliable alternative for the treatment of Kienböck’s disease and may aid in lunate revascularization.

Key words:  Kienböck’s disease , avascular necrosis , vascularized bone graft , lunate