Treatment of Kienbock's Disease Using the 4+5 Extensor Compartmental Vascularized Bone Grafting Procedure: Early Experience.
10.4055/jkoa.2010.45.4.256
- Author:
Sang Jin CHEON
1
;
Jong Min LIM
;
Hui Taek KIM
;
Jeung Tak SUH
Author Information
1. Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea. scheon@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
lunate;
Kienbock's disease;
avascular necrosis;
4+5 extensor compartmental vascularized bone graft
- MeSH:
Bone Transplantation;
Carpal Bones;
Female;
Follow-Up Studies;
Hand Strength;
Humans;
Joints;
Male;
Necrosis;
Osteoarthritis;
Osteonecrosis;
Patient Satisfaction;
Range of Motion, Articular;
Skin;
Track and Field;
Transplants;
Wrist;
Wrist Joint
- From:The Journal of the Korean Orthopaedic Association
2010;45(4):256-263
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Kienbock's disease can be treated with a vascularized bone graft to provide relief of wrist joint symptoms and prevent collapse of the lunate. We evaluated the functional outcome and subjective satisfaction in patients with Kienbock's disease treated with the 4+5 extensor compartmental vascularized bone graft. MATERIALS AND METHODS: We included 6 patients in the study. 3 males and 3 females with an average age of 37.5 years (range 21-49). Kienbock's disease was staged by Lichtman classifi cation based on plain radiography. Three patients were in stage II and three in stage IIIA. Cooney's wrist function score was used to evaluate changes in severity of pain, functional status, range of motion, and grip strength. We also assessed subjective patient satisfaction, carpal height ratio and bone union on the radiographs, and the occurence of complications. The mean follow-up period was 30 months. RESULTS: Four patients had excellent and two had good outcomes of wrist function. Three patients showed excellent subjective satisfaction, and three were good. All patients showed radiographic bone union and no further progression of lunate necrosis. The presurgical carpal height ratio was similar to the value at last follow-up, and there was no radiographic carpal bone collapse. For two cases of Lichtman stage IIIA, the slight degenerative arthritis at the lunocapitate joint observed preoperatively did not change. Skin necrosis and pin track infection were not observed. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft is a reliable procedure for Lichtman stage II and IIIA patients with Kienbock's disease, as it achieved not only pain relief and improvement of range of motion but also maintenance of the intercarpal bone relationship on radiographs, with relatively few complications.
