Dorsal Distraction Plating and Lunate Decortication for Stage III Kienböck Disease: A Novel Technique

Kienböck disease (KD) is a progressive condition and difficult to manage. A number of treatment algorithms exist but there is no clear consensus as to which method produces the best outcome, particularly for Lichtman stage III disease. The majority of the current treatment options for KD emphasize lunate unloading and restoration of biology with bone graft. However, less attention has been given to the protection of the lunate during revascularization process. We report a novel technique of lunate decompression and bone grafting, combined with wrist distraction with or without radial shortening osteotomy via dorsal wrist bridge plating for the treatment of stage II-IIIa/b KD. This technique provides the advantages of distraction of the carpus unloading the lunate after bone grafting and during revascularization without the issues inherent to external fixation. In addition, this technique allows compression through a radial osteotomy site when performed. Our approach to the treatment of KD has incorporated this technique for patients with stage II or IIIa/b disease.