Lunate Revascularization With Temporary Internal Radiocarpal Spanning Fixation for Kienböck Disease

Abstract

Background The goal in the treatment of stages II and III Kienböck disease is to restore lunate vascularity and halt the progression of avascular necrosis. Methods We report the outcomes for patients with stages II and III Kienböck disease treated with fourth extensor compartment artery vascularized bone grafting and temporary radiocarpal spanning internal fixation. Nine patients with a mean age of 28.8 years were included. Mean clinical and radiographic follow-up were 4.9 and 1.9 years, respectively. Results Six patients had no change in Lichtman stage, 2 patients regressed 1 stage, and 1 patient progressed 1 stage. Mean postoperative quick disabilities of the arm, shoulder, and hand (QuickDASH) was 17.4. Mean postoperative visual analogue pain scale (VAS) was 1.8. Patients under age 25 trended toward improved clinical outcomes compared with patients over age 25. Two patients, aged 33 and 65, underwent proximal row carpectomy at a mean 30.5 months postoperatively. Conclusions In conclusion, the use of local vascularized bone graft with temporary internal radiocarpal spanning fixation provides a treatment option with outcomes comparable to existing literature with benefits inherent to internal immobilization.

Dorsal Subluxation of The Proximal Carpal Row with the Use of a Bridge Plate

“…Two previous studies have reported on the use of a temporary dorsal bridge plates in treating Kienböck's disease to distract the carpus for 3 to 6 months as an adjunct with other lunate revascularization or offloading techniques. 9 10 Nicholson et al 10 reported on the outcomes of nine patients (Lichtman Stages II and III Kienböck's disease) treated with a vascularized bone graft from the fourth extensor compartment and temporary dorsal bridge plate. These patients underwent an average of 4.9-year clinical and 1.9-year radiographic follow-ups with comparable functional outcomes as other treatment methods for Kienböck's disease as reported in the literature.…”

“…Recently, a temporary dorsal spanning bridge plate has been used to distract the carpus and offload the lunate during early stages of healing postrevascularization for Stages II to III Kienböck's disease. 9 10…”

“…Recently, a temporary dorsal spanning bridge plate has been used to distract the carpus and offload the lunate during early stages of healing postrevascularization for Stages II to III Kienböck's disease. 9,10 The purpose of this case report is to highlight a case of proximal carpal row dorsal subluxation when using a spanning bridge plate in the treatment of Kienböck's disease.…”