Use of 4+5 extensor compartmental vascularized bone graft and K-wire fixation for treating stage II-IIIA Kienböck's disease

Abstract

Vascularized bone grafts have shown favorable outcomes in Kienböck's disease, preventing the progression of lunate collapse and avascular necrosis. Here we describe our experience using a 4+5 extensor compartmental artery (ECA) vascularized bone graft combined with K-wire fixation. Between September 2010 and June 2013, 9 patients with Lichtman stage II-IIIA disease underwent arthroscopy prior to 4+5 ECA graft placement combined with temporary fixation (scaphocapitate and triquetrum-capitate joints). The average follow-up was 69 months (range, 51-92 months). Changes in pain, range of motion, grip strength, and pinch strength were analyzed. All patients had satisfactory recovery, especially pain relief and grip strength improvement (both P<0.01). Furthermore, magnetic resonance imaging follow-up was critical for monitoring lunate revascularization, especially in the early postoperative period.

Keywords: 4+5 extensor compartmental artery; Artère des compartiments 4-5 des extenseurs; Decompression; Décompression; Fixation par broche de Kirschner; Greffe osseuse vascularisée; K-wire fixation; Kienböck's disease; Maladie de Kienböck; Vascularized bone graft.