Treatment of Preiser disease with vascularized bone graft from the distal radius: a report of two cases

The authors report two cases of women with Preiser disease treated with dorsal distal radius vascularized grafts. In the first case, after minor trauma, the patient had pain in the left wrist of insidious onset and evolution with significant worsening. The radiographic examination showed increased density of the proximal pole of the scaphoid, and magnetic resonance imaging (MRI) showed partial necrosis. Intraoperatively, as the integrity of the cartilage of the proximal pole of the scaphoid was observed, dorsal vascularized distal radius graft was performed using the 1,2 intercompartmental supraretinacular artery. In 4 months postoperatively, MRI showed almost total integration of the graft, and 1 year after surgery, the patient was asymptomatic, with normal mobility of the operated wrist and imaging showing a normal scaphoid. The second case had similar history and clinical picture, but the radiographs showed narrowing and diffuse sclerosis and also osteolytic areas in the proximal pole of the scaphoid; MRI showed diffuse necrosis. The same graft technique was used, considering that there was a good cartilaginous coverage of the scaphoid. After 9 years of follow-up, the patients remain free of pain or functional limitations. In such cases, the vascularized graft technique was effective and, therefore, a good therapeutic option, provided that there is no degenerative changes in the carpus and, especially, the cartilage of the proximal pole is viable.