Vascularized bone graft from the index metacarpal for Kienböck's disease: A case report

Abstract Background Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft. Objective To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease. Methodology The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications. Results This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score. Conclusion Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.

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Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease

Microsurgery ◽

10.1002/micr.20657 ◽

2009 ◽

Vol 29 (5) ◽

pp. 373-378 ◽

Cited By ~ 28

Author(s):

Christophe Mathoulin ◽

Abhijeet L. Wahegaonkar

Keyword(s):

Bone Graft ◽

Vascularized Bone Graft ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Vascularized Bone ◽

Kienbock’S Disease

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Clinical Outcomes of Radial Shortening Osteotomy and Vascularized Bone Graft in Kienböck’s Disease

International Scholarly Research Notices ◽

10.1155/2014/956369 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mohammad Dehghani ◽

Mohammad Ali Moshgelani ◽

Mohammad Hadi Nouraei ◽

Shaghayegh Dehghani ◽

Maryam Gholshahi

Keyword(s):

Bone Graft ◽

Controlled Clinical Trial ◽

Vascularized Bone Graft ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Mayo Wrist Score ◽

The Mean ◽

Group B ◽

Vascularized Bone ◽

Kienbock’S Disease

The aim of this study was to compare two surgery methods including radial shortening and radial shortening combined with vascularized bone graft for treatment of stage II or IIIa of Kienböck’s disease. It is a randomized, controlled clinical trial, which was carried out in 2011–2013. Twenty-four patients were assigned equally to radial shortening group (A) or radial shortening combined with vascularized bone graft group (B). The outcome was assessed by Mayo Wrist score before and 9 months after surgery. The mean Mayo Wrist score (SD) was 27.1 (15.4) and 32.5 (18.3) before surgery and 74.6 (5.4) and 85.8 (5.1) after surgery for groups A and B, respectively. The mean score increased in both groups, and it was higher in group B significantly. Radial shortening combined with vascularized bone graft is a valuable method which can be more effective than radial shortening alone, in early stages of Kienböck’s disease. This trial is registered with IRCT201404127841N5.

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