Lunate revascularisation associated to a shortening osteotomy of the radius for the treatment of Kienbock's disease

Kienbock's disease was described by Kienbock in 1910. It is an avascular necrosis of the lunate, its natural history evolves to the collapse of the carpus with a secondary degenerative evolution. Epidemiology is poorly known and is still discussed, except for post traumatic cases. The negative ulnar variance is considered by a majority of authors as a predisposing factor to Kienbock's disease. The therapeutic principle evolves according to stages of the diagnoses. Shortening of the radius and lengthening of the ulna are satisfactory processes in the biomechanical plan because they increase the constraints transmitted by the ulna by discharging the lunate. Revascularisation of the lunate associated with a shortening of the radius seems a more daring and more ambitious technique. As for the very advanced forms, they require palliative techniques such as wrist denervation, first raw carpectomy or four bone arthrodesis. We report our experiment of a series of 22 cases treated between 1994 and 2000 with a minimum 5 year-follow-up, associating a revascularisation of the lunate by a former graft