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
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Article info
Publication history
Accepted:
October 11,
2004
Received:
December 2,
2003
Footnotes
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Identification
Copyright
© 2005 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
