Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years

Abstract

We inserted a pronator quadratus pedicled bone graft into the avascular lunate with preservation of its corticocartilaginous portion for the treatment of Kienböck disease. Twenty-seven patients (14 men, 13 women; mean age, 42 years (range 17–66 years)) were treated between September 2005 and July 2014 and followed up from 2 to 12 years. Three patients had Lichtman stage II disease, 13 had stage IIIA, and 11 had stage IIIB. Among them, 18 patients showed radiological improvement in lunate morphology. The Lichtman stage was unchanged in 23 patients and aggravated in four patients. The Stahl index was significantly decreased, but grip strength was significantly improved and 18 patients did not have any wrist pain during daily activities. Although our technique did not restore the already changed carpal malalignment, it improved lunate morphology. Clinically, it provided satisfactory pain levels in two-thirds of the patients and grip strength was improved. Level of evidence: IV

The use of fourth extensor compartment artery bone flap in Kienböck’s disease

“…There are few studies of large patient series in the literature. [15][16][17] In this study, the results of patients who underwent bone flap surgery were evaluated and there was no control group for comparison of the effectiveness of the treatment.…”

Matching Kienböck's Treatment Options to Specific Features of Each Case

“…[50][51][52][53][54][55] For a successful purely osseous flap, both the proximal and distal articular surfaces must be supported by subchondral bone that is merely ischemic but not terminally necrotic. 3,13,56,57 Twenty-six patients followed for 31 months after distal radius 4,5-extensor compartment vascularized bone flaps achieved 71% of contralateral wrist ROM, 89% of contralateral GS, and 77% demonstrated no further collapse. 58 Thirteen patients (11/13 L/S stage IIIA) followed at 32 months after distal radius 4,5-extensor compartment vascularized bone flaps without additional unloading demonstrated no collapse or progression with GS improving from 60 to 88% of contralateral, wrist flexion from 39 to 53 degrees, and wrist extension from 41 to 56 degrees.…”

Comparison of Long-term Outcomes between Nonoperative Treatment and Vascularized Bone Graft for Kienböck Disease: A Systematic Review and Single-Arm Meta-Analysis

“…While the indications for a VBG have been established as Lichtman stages I, II, and IIIA, the precise indications remain unclear. 7) Since Hori et al 8) successfully introduced revascularization to the necrotic bone, several anatomical sites have been reported as available VBG donor sites for patients with Kienböck disease: VBGs from the distal radius 2 5 6) or metacarpal 2 9) were available from the dorsal aspect of the wrist; vascularized 10) or pronator quadratus pedicled bone grafts 11) from the distal radius; and vascularized pisiform transfer 12) from the volar aspect of the wrist. The distal femur 13) and iliac bone 14) were also available as donor sites for free VBGs.…”