Superselective angiography of the wrist in patients with Kienböck’s disease

Abstract

Background Microvascular problems like increased intraosseous pressure or venous congestion may influence the development of Kienböck’s disease. We examined if wrist position modifies the blood flow in the nutrient vessels. Methods Retrospective analysis of 17 patients with Kienböck’s disease who had a superselective microangiography of the radial, ulnar and interosseous artery in different wrist positions under general anaesthesia. We analysed the data with Fisher’s exact and Wilcoxon-test. Results We found vessels that entered the bone, that ended at the bone edge, and that supplied a vascular plexus. The origins were the anterior interosseous artery in 10 of 17 cases, the radial artery in seven cases, and the ulnar artery in five cases. Movement of the wrist could reduce or stop the blood flow. Type of lunate configuration showed no significant influence on the blood supply in neutral position. Conclusion The radial, ulnar, and anterior interosseous artery contribute to the vascular supply of the lunate bone in different combinations. Wrist movement can reduce blood flow to the lunate bone. Electronic supplementary material The online version of this article (10.1186/s12891-019-2492-5) contains supplementary material, which is available to authorized users.

Kienbock’s Disease: A Case Study

“…Depending on the degree of damage there are several surgical options available: Revascularization, capitates-shortening osteotomy, joint leveling, metaphyseal core decompression, proximal row carpectomy, fusion, and arthroplasty (Frerix et al, 2016;Hong et al, 2019;Kim et al, 2019).…”

Superselective Catheter Angiographies of the Wrist (SCAW): Approaches for Vascularized Bone Grafts

“…We performed a secondary analysis of the study described in “ Superselective angiography of the wrist in patients with Kienbock’s disease ” [ 18 ].…”

“…During routine clinical practice, wrist surgeons are also recurrently faced with the challenge of evaluating possibilities for vascularized bone grafts in complex cases. Publication of our primary work [ 18 ] triggered the hope for a reproduciable imaging tool to measure the peripheral arteries of the wrist as another application of SCAW.…”

Kienböck’s disease: Where do we stand?

“…29,30 Recently Kim et al showed the wrist position-dependent perfusion of the lunate using super-selective angiography of the radial, ulnar, and interosseous artery. 31 They found the maximum blood flow during neutral wrist position, which decreased with extension or flexion of the wrist. They concluded that prolonged wrist flexion or extension in pain or splinting, occupation might contribute to the pathogenesis of the disease.…”