gms | German Medical Science

Objectives/Interrogation: Avascular necrosis of the carpal bones is a relatively rare condition of the wrist and can be divided into degenerative and post-traumatic. Post-traumatic necrosis is very common after neglected fractures or dislocations of the scaphoid or the lunate. Our aim was to create local protocols based to results and patient's satisfaction. We also present clinical cases and compare different techniques, complex or simple.

Methods: We present a prospective study that included 16 patients with carpal bone necrosis. We divided the patients into degenerative and post-traumatic necrosis and the surgical interventions were represented by reconstructive procedures such as: vascularized (free and local) or non-vascularized bone grafts, salvage procedures or even modern replacement implants. Distal radius and medial femoral condyle were most common donor places.

Results and Conclusions: Reconstructive procedures was found in 14 patients without a second intervention. Two patients needed a secondary intervention and the final results were satisfying. The wrist range of motion was improved in all the patients with reconstructions and the pain was significantly decreased or totally gone.

The avascular necrosis of the carpal bones can be very challenging and the indications have to be really precise. Reconstruction of the wrist is sometimes technically demanding surgery and the rehabilitation of the patients can be prolonged and difficult. If a standard protocol is used for all the patients, the results will significantly improves and the patients satisfaction too. Replacement implants are technical demanding procedures but also promising due to its bone-like properties.