Functional outcome following vascularised pedicle graft from 4, 5 extensor compartment artery in patients with Kienbock’s disease

Abstract

Objective: Surgical management of Kienbock’s disease is debatable and there is no clear evidence of any procedure more efficacious over the other. Our aim was to evaluate the functional and radiological outcome of patients with Stage 2 and 3 Kienbock’s disease who underwent vascularised bone graft from 4, 5 extensor compartement artery to lunate. Methods: We retrospectively reviewed patients, who underwent vascularised bone grafts (VBG) using 4 and 5 th extensor compartment artery for Kienbock’s disease, between 2013 and 2019. We excluded those secondary to trauma, negative ulnar variances and advanced stage of disease. We used the Visual Analogue Score (VAS) for pain, qDASH for the functional outcome and radiological assessment at final follow up. Results: Ten patients underwent VBG for Kienbock’s disease stage 2 and 3a. They were all operated by a single specialist hand surgeon, using the same surgical technique where a bone graft was harvested from the distal dorsal radius with vascular pedicle from the 4 th and 5 th extensor compartment artery. The average age at surgery was 40.6 years. There were 7 males and 3 females. The mean follow-up is 30 months. At the final follow up the mean VAS is 2.6 out of 10 against 9.5 pre-operatively and mean qDASH is 25.4/100 against 70.7/100 pre-operatively. Radiographs at the final follow up showed no progression of disease. All patients reported improvement in range of movement following surgery. Conclusions: Our study has demonstrated that vascularised bone graft is a viable treatment option for Kienbock’s disease stage 2 and 3 on a carefully selected group of patients with improvement in pain and function.