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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Lunate preserving pronator quadratus pedicled bone graft in the treatment of Kienböck’s Disease

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  • presenting/speaker Young Ho Shin - Asan Medical Center, Songpa-gu, South Korea
  • Jun O Yoon - Asan Medical Center, Songpa-gu, South Korea
  • Jae Jung Ryu - Asan Medical Center, Songpa-gu, South Korea
  • Tae Kyoon Lee - Asan Medical Center, Songpa-gu, South Korea
  • Shin Woo Choi - Asan Medical Center, Songpa-gu, South Korea
  • Jae Kwang Kim - Asan Medical Center, Songpa-gu, South Korea
  • Gwan Bum Lee - Asan Medical Center, Department of Orthopedic Surgery, Songpa-gu, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-671

doi: 10.3205/19ifssh0017, urn:nbn:de:0183-19ifssh00174

Published: February 6, 2020

© 2020 Shin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Pronator quadratus (PQ) pedicled bone graft (BG) was one of the vascularized BG option for the treatment of Kienböck's Disease. We inserted a pronator quadratus pedicled bone graft to the avascular lunate with preserving the cortico-cartilaginous portion of the lunate.

Methods: Twenty seven patients with Kienböck's disease (three patients of Lichtman stage II, 13 patients of IIIA and 11 patients of IIIB) were treated by lunate preserving PQ pedicled BG between September 2005 and July 2014 and followed more than two years. There were 14 men and 13 women; the mean age at the time of surgery was 42.4 ± 13.4 years (range, 17-66 years). Radiological changes including lunate morphology, Lichtman stage and radiological parameters were compared between preoperative and final follow up. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores, pain VAS were also evaluated.

Results and Conclusions: Eighteen patients (66.7%) showed radiological improvement in lunate at least one of sclerosis, cystic changes or fragmentations after operation: sclerosis in 14, cystic changes in three, and fragmentation in five patients. The preoperative Lichtman stage was not changed in 23 patients, but aggravated in 4 patients. In radiological evaluations, Stahl index was significantly decreased after operation (p=0.012), but no significant differences were observed in the radioscaphoid angle and carpal height ratio. The grip strength was significantly improved after operation (p<0.001), but was not in wrist ROM. The mean DASH score was 16.7 ± 14.0 (range, 1.7-50.8) and 18 patients (66.7%) did not have any pain at the wrist during daily activity. Lunate preserving PQ pedicled BG could improve lunate morphology in some extent, but did not restore the already changed carpal malalignment. However, this technique was effective in pain control and grip strength improvement. This technique could be a useful alternative to previous vascularized BG techniques in the treatment of Kienböck's Disease.