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

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Radiology

Background:

• Kienbock's disease is avascular necrosis of the lunate bone.
• Early intervention in pre-collapse stages involves joint leveling, unloading, and revascularization.
• Understanding disease progression from ischemia to collapse and arthritis is crucial.

Observation:

• Two cases of pre-collapse Kienbock's disease underwent surgical intervention.
• Preoperative and postoperative assessments included pain scores, range of motion, grip strength, Quick DASH, carpal alignment, and lunate height.
• Mean follow-up was 12 years, with MRI and X-rays utilized for evaluation.

Findings:

• Surgical procedures resulted in significant pain reduction and improved grip strength.
• Patients maintained pre-operative carpal alignment, with no further lunate collapse observed.
• Moderate restriction in wrist range of motion was noted, but joints remained painless and stable.

Implications:

• Lunate preservation, decompression, and bone grafting yield satisfactory outcomes for pre-collapse Kienbock's disease.
• Surgical success is indicated by a painless, stable wrist and enhanced functional capacity for daily living.
• These findings support early surgical intervention to prevent disease progression and improve patient quality of life.