SEMILUNATE REVASCULARISATION AFTER KIENBÖCK NECROSIS USING A VASCULARISED ISLAND BONE GRAFT ON THE ANTERIOR ASPECT OF THE RADIUS: RESULTS AT MINIMUM THREE YEARS FOLLOW-UP

Abstract

Purpose: We report our experience with vascularised bone grafts harvested from the anterior aspect of the radius for the treatment of Kienböck disease. We reviewed our patients at minimum three years, average 67 months.

Material and methods: We treated 22 patients with Kienböck disease, eight women and fourteen men, mean age 31.4 years (18–63). Pain was present in all cases and was disabling in nineteen. After systematic computed tomography and magnetic resonance imagine (MRI), the Büchler classification was stage II=8, stage IIA=10 and stage IIIB=4. The transverse anterior artery of the carpus arises from the radial artery and supplies blood to the medial part of the radial epiphysis. The pediculated bone graft fed by this artery can be harvested via the same anterior approach as used to position it in the semilunate for revascularisation. Radial shortening was performed in all cases. The patients were immobilised until the radius healed.

Results: Mean follow-up was 67 months (36–104). Pain resolved completely in all twenty patients. Two patients nevertheless reported moderate pain occasionally. Mean active motion was greater than 71°. Mean time to resumption of former activities was 3.5 months. Postoperative MRI, performed at mean 8 months, demonstrated complete revascularisation of the semilunate in six cases, stable lesions in five, and one failure requiring secondary palliation. There were four cases of late healing of the radial osteotomy and one reflex dystrophy. There was a direct correlation between Kienböck disease stage and final outcome.

Conclusion: Use of a vascularised graft harvested from the anterior aspect of the radius for revascularisation of the semilunate associated with radial shortening has provided encouraging results. Long-term follow-up is needed to verify these results.