Treatment of Kienbock's disease using a fourth extensor compartmental artery as a vascularized pedicle bone graft

Background: Vascularized bone grafts for the treatment of Kienbock's disease may facilitate revascularization and remodeling of the avascular lunate. The aim of this study was to evaluate the radiological and clinical results obtained when a fourth extensor compartmental artery (ECA) bone graft was used to treat Kienbock's disease. Methods: Between May 2009 and June 2012, 13 patients (6 men, 7 women) with Kienbock's disease were treated with placement of fourth ECA vascularized bone grafts. The mean patient age was 39.2 (20-58) years, and the mean follow-up period was 32.5 (12-72) months. At the time of surgery, One patient had Lichtman's stage II Kienbock's disease, 11 stage IIIA disease, and one stage IIIB disease. We measured the pre-and post-operative ranges of motion, pain, grip strength, and radiological parameters, including the carpal height ratio and the radioscaphoid angle. Results: At the last follow-up, pain was significantly reduced, and grip strength had improved from 60.5% to 87.8% relative to that of the contralateral side. The mean range of motion for flexion had improved from 39 degrees to 53 degrees while that of wrist joint extension improved from 41 degrees to 56 degrees. There were little or no changes in either the carpal height ratio or the radioscaphoid angle (both p values > 0.05). Conclusions: Placing of a fourth ECA vascularized bone graft is a reliable alternative to other revascularization procedures for treatment of Kienbock's disease. Such grafting is effective, minimally invasive, and associated with a low risk of pedicle kinking. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.