Long-Term Results of Vascularized Bone Graft for Stage III Kienbock Disease

Purpose Vascularized bone grafting (VBG) is one of the therapeutic approaches for treating advanced Kienbock disease; however, few reports on long-term outcomes are available for this technique. The purpose of this study is to evaluate long-term results by following up patients with stage III Kienbock disease for more than 10 years after VBG. Methods The study included 18 patients with advanced Kienbock disease (Lichtman stage IIIA, n = 10; stage IIIB, n = 8) who received VBG between 1996 and 2001 and were followed up for at least 10 years. Eleven patients received transplantation from the metacarpal base and 7 patients from the distal radius. Radial shortening and capitate shortening were performed in 5 and 2 stage IIIB patients, respectively. Results The mean follow-up period was 12 years, 3 months. Based on the Mayo Modified Wrist Score, clinical results were excellent in 8 patients, good in 7 patients, and fair in 3 patients. The Stah1 index and carpal height ratio were not improved in stage IIIA patients who received bone graft alone, whereas significant improvement was observed in stage IIIB patients who received shortening, as well. Conclusions Vascularized bone grafting for stage III Kienbock disease demonstrated favorable long-term results and is recommended as a surgical treatment. (Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)