[Vascularized pisiform transfer in place of lunatum for Kienböck's disease]

There is a specific vascularization of the pisiform bone depending on the cubito-dorsal artery, branch of the ulnar artery. The vascularized pisiform bone may be transferred in place of the excised lunatum. The aims are to decrease pain when keeping the mobility, to replace a dead bone, to maintain the distance between scaphoid and triquetrum and radius and capitatum, by preventing the carpal collapse. X-rays and a MRI are performed. The vascularized transfer is indicated at stage III of the usual classifications. The technique is described, insisting on the transferred bone stabilization using ligament reconstructions. Radial shortening or scapho-capitate limited arthrodesis may be combined to reduce the stress on the transferred bone. Fifty-one cases have been performed at stage IIIa or IIIb and sometimes IV of the disease. The maximum follow-up is 15 years. The pain has decreased constantly. Motion in flexion-extension has an increase of more than 35°, radial and ulnar deviation of more than 14°. Strength has been slightly modified to more than 10%. The complications are: one case of "complex regional pain syndrome", one infection reoperated and one infection cured by antibiotics; one reoperation for a proximal row carpectomy. Results of this technique have been published in the literature. This technique provides regularly good results with a long follow-up. A precise technique is mandatory.