Bone Grafting and Unloading Procedures for Stage 1-3a Kienbock's Disease

Kienbock's disease is an avascular necrosis of the lunate. Although the etiology is not well known, the progression of the disease from ischemia to lunate collapse to arthritis is well documented. In the pre-collapse stages of Kienbock's disease, procedures for joint leveling, unloading the lunate, and revascularization are performed. The aim was to analyze the usual presentation of patients with Kienbock's disease clinically and radiologically to assess the ulnar variance, carpal alignment, carpal height preoperatively and postoperatively, and the outcome of the above-mentioned surgical procedure.

Two cases of pre-collapse Kienbock's disease were operated over a span of 1 year. The above-mentioned objectives were met in different surgical ways. Data recorded were pain scores, range of motion, grip strength, Quick DASH scores, Youm's index, and scapholunate angle. X-rays were used to record Ulna variance, carpal alignment, and carpal height preoperatively and postoperatively. MRI of the wrist was also done. The mean follow-up was 12 years. The patients had almost complete resolution of pain. The range of dorsiflexion was 25°-40° and the range of palmar flexion was 25°-30°. The mean quick DASH score was significantly reduced. There was a significant improvement in grip strength. All patients had preservation of pre-operative carpal alignment. There was no further collapse of the lunate compared to pre-operative radiographs.

Lunate preservation, decompression, and bone grafting produce satisfactory outcomes. Even though there is a moderate restriction of range of motion at the wrist joint, it produces a painless and stable joint. There is a significant improvement in grip strength which helps patients to do all activities of daily living.