"Salvage" procedures in the treatment of Kienböck's disease. Proximal row carpectomy and total wrist arthrodesis.

In symptomatic stage III Kienböck's disease, proximal row carpectomy may be considered not only as a secondary "salvage," but also a primary reconstructive procedure. The need for concomitant radial styloidectomy is assessed intraoperatively after removal of the proximal row. Distraction resection arthroplasty is an alternative for patients with full-thickness cartilage loss on the capitate head or in the lunate fossa surpassing 3 mm in diameter. For patients with generalized carpal arthrosis (stage IV Kienböck's disease) or unsuccessful previous reconstructive surgeries, total wrist arthrodesis is the most reliable procedure for pain relief. PRC is an acceptable alternative to TWA for stage IV disease if the patient is willing to risk having some residual pain to preserve wrist motion. Transection of the articular branch of the posterior interosseous nerve may be a useful adjunct to these procedures.