Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease

Abstract

Kienböck, a German radiologist, described avascular necrosis of the lunate (Kienböck's disease) in 1910. The epidemiology and etiology are not well-known and always has been debated. A negative ulnar variance is considered as a predisposing factor for Kienböck's disease by the majority of the authors. The treatment depends upon the stage of the disease at the time of presentation and diagnosis. Radial shortening and lengthening of the ulna are biomechanically satisfactory procedures because they increase the load sharing of the ulna and result in decompression of the lunate. Revascularization of the lunate by shortening of the radius may appear to be a very bold and ambitious technique. In very advanced cases, palliative procedures like wrist denervation, resection of the proximal carpal row, or wrist arthrodesis are the techniques resorted to. We report our experience of a series of 22 operated cases between 1994 and 2000 with a minimum follow up of 5 years. All cases were treated with an anterior vascularized bone graft based on the volar carpal artery associated to an osteotomy of the radius.

Outcome of Kienböck’s disease in twelve cases: a mid-term follow-up study

“…(17) Similar results were observed in Mathoulin and Wahegaonkar's study, which consisted of a series of 22 patients, 77% of whom showed evidence of revascularisation. (18) In the present study, all the patients who underwent VBG (n = 8) showed radiologic evidence of revascularisation (Fig. 1).…”

Vascularized bone grafting from the dorsal distal radius for Kienböck's disease: Technique, indications and review of the literature

“…Mathoulin and Wahegaonkar [14] described a technique of radial shortening osteotomy with VBG based upon the transverse volar carpal artery to treat 22 patients with varying stages of Kienböck's disease. After an average of 74 months of follow-up, 18 patients were completely pain-free and gains in range of motion and grip strength were noted in all patients.…”

Le transfert osseux vascularisé prélevé sur la face antérieure du radius dans la reconstruction des os du carpe

“…Ce sont les travaux de Haerle et Mathoulin [36][37][38][39] qui ont permis de décrire une technique de prélèvements fiables et reproductibles pour le greffon vascularisé prélevé sur la face antérieure du radius.…”

“…Nous avons réalisé 30 dissections cadavériques qui ont montré l'existence constante d'une artère transverse antérieure du carpe [37,39]. Il existe à la partie antérieure distale des deux os de l'avant-bras une anastomose du réseau artériel entre les artères radiale et ulnaire.…”