Vascularised bone graft for Kienböck disease: Preliminary results

Hermans, Stijn; Degreef, Ilse; Smet, Luc De

doi:10.1080/02844310601127441

Cited by 10 publications

(11 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Kakinoki et al [4] used a combination of a pedicled vascularised bone graft from the 2/3 compartment of the dorsal radius, radial osteotomy and arthrodesis in eight patients and had 7/8 with a good/excellent short-term result. Hermans et al [5] used a pedicled vascularised bone graft from the dorsal radius in eight patients and had 6/8 patients with a good/excellent result after 13-42 months. Moran et al [6] used a 4/5 extensor compartmental vascularised bone graft for the treatment of Kienböck disease in 26 patients with good short-term results with a mean follow-up of 30 months.…”

Section: Discussionmentioning

confidence: 98%

“…Treatment options ranges from mechanical unloading and joint levelling procedures, to salvage methods such as proximal row carpectomy, intercarpal arthrodesis, and total wrist fusion. Also revascularisation of the lunate has been used with free vascularised bone graft [3] or a pedicled bone graft [4][5][6][7], but still the ideal treatment is in doubt.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term results after vascularised bone graft as treatment of Kienböck disease

Kirkeby¹,

Palffy²,

Hansen³

2013

Journal of Plastic Surgery and Hand Surgery

View full text Add to dashboard Cite

The aim of this study was to present the long-term results in a small series of patients with Kienböck disease treated with a pedicled vascularised bone graft from the 4/5 extensor compartment of the distal radius as the only surgical treatment. In the period 2002-2006, five patients, three men and two women, mean age 41 years (22-54) were operated on using a pedicled vascularised bone graft from the 4/5 extensor compartment of the distal radius as described by Sheetz et al. Four patients were staged as Lichtman stage 2 and one as Lichtman stage 3. At the follow-up examination with radiographs and clinical examination at a mean of 7.4 years (5-9) after the operation, they all stated that they were satisfied with the operation. None of the patients had any further surgery in the observation period. Four patients were fully employed, and only one had changed employment due to his hand. The last patient was on a medical pension due to other medical causes. In all patients, no sign of progression was found of the radiological changes in the lunate and in all patients the arches of Gilula were unchanged without signs of carpal collapse. So, in this small series, a pedicled vascularised bone graft from the 4/5 extensor compartment of the distal radius as the only surgical treatment provided good long-term results in patients with stage 2 and 3 Kienböck disease.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Long-term results after vascularised bone graft as treatment of Kienböck disease

Kirkeby¹,

Palffy²,

Hansen³

2013

Journal of Plastic Surgery and Hand Surgery

View full text Add to dashboard Cite

show abstract

“…Lichtman revised this system [50]. The Stahl-Lichtman classification system describes four stages of progressive degeneration of the carpus secondary to AVN of the lunate [34,68] (Table 3).…”

Section: Kienböck's Diseasementioning

confidence: 99%

“…& Mechanical: immobilization, joint leveling/unloading (radial shortening/wedge osteotomy) [10,64,65,73,97], capitate shortening osteotomy (CSO) with [93] or without [1,25,92] VBG, arthroscopic core decompression of the lunate [4], and metaphyseal core decompression of the radius or ulna [36] & Biological: revascularization-free iliac bone grafting [22], pedicled dorsal distal radius [34,60], direct implantation of an arteriovenous pedicle [35,78,85], pronator quadratus pedicle flap [57], pisiform transfer [14], and index metacarpal [5] & Salvage: wrist denervation, lunate excision with [71] or without replacement [44], PRC [63], limited [86,99] or total wrist fusion [51], and total wrist arthroplasty Almost all reports on treatment are retrospective, suggesting the need for prospective, comparative studies. Joint leveling/unloading procedures, in patients with ulnarnegative variance, are performed under the premise of changing the abnormal radioulnar geometry to decrease excessive pressure through the lunate [54,64].…”

Section: Kienböck's Diseasementioning

confidence: 99%

Vascularized Bone Grafts for the Treatment of Carpal Bone Pathology

Derby

Murray

Shin

et al. 2013

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.

show abstract

“…[26][27][28][29][30][31] From the dorsal aspect of the wrist, the extensor compartmental vascularized distal radius 32,33 and the vascularized metacarpal base based on the dorsal carpal artery 34,35 can be found. From the palmer aspect, vascularized os pisiform transfer 36,37 and distal radius transfer based on the palmer carpal artery 38,39 are available.…”

mentioning

confidence: 99%

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

et al. 2016

View full text Add to dashboard Cite

Previous literatures described various methods of treatment for Kienböck disease depending on the patient characteristics, the severity of the symptom, and radiological staging. 1-8 Treatment options range from conservative measurements to surgical interventions. 9-12 Several authors advocated a biomechanical approach to reduce load transmission on the necrotic lunate, [13][14][15][16][17][18][19] and good clinical results have been reported in joint leveling procedures such as radial shortening or ulnar lengthening 20-22 and in radial or ulnar wedge osteotomy. 23,24 Hori et al 25 introduced a biological approach of revascularization for necrotic bones based on their experimental results. Since then, there have been several donor sites available for vascularized bone graft in the treatment of AbstractPurpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients. Average age was 32 years, and radiological grading according to Lichtman classification was stage 2 in 8 patients, stage 3A in 10 patients, and stage 3B in 10 patients. Temporary pinning fixing the midcarpal joint was conducted for 10 weeks postoperatively. Results Follow-up periods averaged 70 months. Pain reduced in 27 patients, and visual analog scale for pain of pre-and postoperative level averaged 59 and 18. Range of wrist flexion and extension motion improved from 87 to 117 degrees, and average grip strength improved from 21 kg preoperatively to 33 kg postoperatively. Carpal height ratio had almost no change from 0.52 to 0.53. Fragmentation of necrotic bone healed in 7 of the 14 cases. Comparative analyses of functional and radiological outcomes between three donor sites found no significant difference. Conclusion Three different vascularized bone grafts from the dorsal wrist and hand area demonstrated favorable and comparable functional outcomes. It was technically important to elevate vascular bundle with surrounding retinaculum or fascia, to include sufficient periosteum, and to insert the vascularized bone as the cortex aligned longitudinally.

show abstract

Vascularised bone graft for Kienböck disease: Preliminary results

Cited by 10 publications

References 11 publications

Long-term results after vascularised bone graft as treatment of Kienböck disease

Long-term results after vascularised bone graft as treatment of Kienböck disease

Vascularized Bone Grafts for the Treatment of Carpal Bone Pathology

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

Contact Info

Product

Resources

About