AAHS - Stage III Kienb�ck Treated with Vascularized Bone Graft and Dorsal Spanning Plate

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Stage III Kienb�ck Treated with Vascularized Bone Graft and Dorsal Spanning Plate
Jeremy Miles, MD; David S Ruch, MD
Duke University, Durham, NC

Hypothesis: Advanced stage lunatomalacia has been considered a difficult problem with multiple proposed treatments. We hypothesized that a combined surgical approach to treat stage 3 Kienb�ck disease would yield acceptable clinical and radiographic results with minimal complication.
Methods: A retrospective review was performed over a four year period to identify patients with Lichtman�s stage 3 Kienb�ck disease with lunate collapse confirmed on advanced imaging (MRI and/or CT) who were treated with a combined method of lunate debridement, local cancellous and vascularized bone grafting, and temporary dorsal wrist-spanning plate with subsequent plate removal at 3 months. Demographic, clinical, and radiographic data was reviewed.
Results: Four patients (five wrists) met inclusion criteria. Average age was 20.4 years (range 13-34 years) with symptoms for an average of 6 months (3-12 months) preoperatively. Mean follow-up was 22 months (9-41 months). All wrists were Lichtman stage 3 at the time of initial surgery. Three wrists did not change stage, one wrist progressed to stage 4, and one wrist improved to stage 2 on final radiographic follow-up. Average VAS decreased from 5.3 preoperatively to 1.75 at final follow-up. Wrist range of motion averaged 71� extension (50-85�) and 69� flexion (30-90�) at the most recent follow-up visit. All patients returned to their pre-symptom level of activity. One patient underwent arthroscopic graft excision 28 months post-operatively for painless dorsal prominence and restricted wrist motion.
Summary Points:

We demonstrate promising short-term results in a small cohort of patients utilizing a combined technique of lunate debridement, cancellous bone grafting, vascularized bone grafting, and temporary internal stabilization with bridge plate for the treatment of lunatomalacia with collapse.
Long-term outcome studies and comparative studies with other surgical interventions for Stage 3 Kienb�ck disease are necessary to further validate our method of treatment.

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