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. © 2009 Wiley-Liss, Inc. Microsurgery 2009.