Lunate Excision and Vascularized Os Pisiform Transfer in Advanced Kienbock's Disease

ABSTRACT

PURPOSE: There are many controversies concerning therapeutic guidelines for the treatment of Kienbock's disease. The purpose of this study is to evaluate the clinical and radiological result of lunate replacement by vascularized os pisiform transfer in advanced Kienbock's disease. MATERIALS & METHODS: There were two men and three women. The mean age was 55 years, ranging from 41 to 70. According to Lichtman's classification, three cases were stage IIIb and two cases were stage IV. RESULTS: At the period of follow up, pain during motion was markedly diminished in all patients, the arc of motion ranged on average from 49 degrees of flexion to 53 degrees of extension and the grip power of the affected hand reached on average 83% compared with the contralateral side. Clinical results assessed by DASH and modified Mayo score showed 8 and 90. On plain X-rays, carpal height ratio and radioscaphoid angle were not changed postoperatively. CONCLUSION: Lunate excision and vascularized os pisiform transfer is a reliable alternative method for the treatment of advanced Kienbock's disease.