Kienbock's disease: treatment by implantation of vascular pedicle and bone grafting.

Eleven patients with stage II and IIIA Kienbock's disease treated with vascular pedicle implantation and bone grafting were reviewed to determine the long term efficacy of the procedure. Eight wrists had a negative ulnar variance and three wrists had a neutral ulnar variance. The procedure involved implanting the second dorsal metacarpal artery and its venae commitantes into a hole made in the lunate through a dorsal approach. Cancellous bone graft from the dorsal aspect of the distal radius was loosely packed in the hole to secure the pedicle. Follow-up was from 37 to 140 months with an average of six years. Nine patients had significant long term pain relief, improved function, and required no additional procedures. In two patients, continued pain necessitated proximal row carpectomy at two and 4.5 years postoperatively. Ten of the eleven patients had no worsening of their radiographic staging, but in no patient was the architecture of the lunate restored. There were no complications. The results are promising enough to recommend consideration of this procedure in the early stages of Kienbock's disease in patients with a neutral or negative ulnar variance.