Combined vascularized bone graft and scaphocapitate fusion in the treatment of stage III(b) Kienbock's disease: a cohort study involving 11 patients

Background: The purpose of this study was to evaluate the results of combined scaphocapitate fusion and revascularization of the lunate for patients with stage III(b) Kienbock's disease. Methods: Eleven patients with stage III(b) (Lichtman classification) Kienbock's disease were identified. The inclusion criteria were stage III(b) Kienbock's disease according to the Lichtman classification, with no previous surgical interventions, no radiocarpal arthritis, and intact lunate articular surfaces proven by plain radiographs, MRI, and intraoperative wrist arthroscopy. All patients were scheduled for scaphocapitate fusion and lunate revascularization. Intraoperative wrist arthroscopy was mandatory for the plan of treatment. Results: In all patients there was radiographic evidence of union and bone consolidation at the carpal fusion site at a mean of 8 wk. MRI was obtained 1 yr after the procedure and showed revascularization of the lunate in all patients. Postoperative serial radiographs showed improvement and maintenance of the lunate height and diameter. Postoperatively, wrist extension range of motion showed a mean improvement of 11.3%, while wrist flexion range of motion showed a mean improvement of 24.32%. Mean improvement in grip strength was 106.33%. Visual analog scale (VAS) for pain showed a mean improvement of 71.02%. Disability of the Arm, Shoulder, and Hand (DASH) score showed a mean improvement by 77.67%. Conclusions: Revascularization and restoration of lunate anatomy together with an unloading procedure gives better results in the treatment of stage Ill (b) Kienbock's disease. This technique prevents further collapse of the lunate with satisfactory long term results. Intraoperative wrist arthroscopy is mandatory to prove the intact lunate articular surface.