The Use of Second Metacarpal Vascular Pedicle Graft and Temporary Scaphotrapeziotrapezoid Fixation for the Treatment of Kienbock's Disease.
10.4055/jkoa.2006.41.4.589
- Author:
Jae Sung SEO
1
;
Oog Jin SHON
;
Jae Hyeung HAN
;
Sam Kuk PARK
;
Jin Hyuk KO
;
Sung Min CHUNG
Author Information
1. Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea. sjs@med.yu.ac.kr
- Publication Type:Original Article
- Keywords:
Kienbock's disease;
Vascular pedicle graft;
Lunate
- MeSH:
Classification;
Follow-Up Studies;
Hand Strength;
Humans;
Osteonecrosis*;
Retrospective Studies;
Sclerosis;
Transplants*;
Wrist
- From:The Journal of the Korean Orthopaedic Association
2006;41(4):589-595
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Revascularization is a useful method for treating Kienbock's disease. The aim of this study was to evaluate the use of the second dorsal metacarpal vascular pedicle to treat Kienbock's disease. MATERIALS AND METHODS: A retrospective study was carried out on 9 patients who had undergone vascular pedicle graft for Kienbock's disease between 1999 and 2003. The mean follow up period was 35 months. At the time of surgery, 2 patients were graded as stage II, 6 as IIIa and 1 as IIIb. The ulnar variance was neutral in all cases. A vascular pedicle graft using second dorsal metacarpal vessel were performed and temporary scaphotrapeziotrapezoid (STT) fixation were applied for 6 months. RESULTS: Wrist motion except for the radial deviation and grip strength had improved significantly. The patients returned to work after an average of 22 weeks. Resorption of the sclerosis was observed in 7 cases, but lunate collapse was observed in the simple radiograph in 6 cases. According to Lichtman's criteria, 7 cases were satisfactory but 2 cases with a relative old age were unsatisfactory. According to Nakamura's classification, 5 cases were good, 3 cases were fair and 1 case was poor. CONCLUSION: In Kienbock's disease with neutral ulnar variance, a revascularization procedure of vascular pedicle graft with temporary STT fixation is a good treatment method but the patient's age should be considered when determining the revascularization procedure. A prospective study will be needed to determine the optimal duration of temporary STT fixation.
