External fixation for the treatment of Kienböck's disease

With the advent of magnetic resonance imaging, the diagnosis of avascular necrosis of carpal bones can be made early, well before collapse and derangement of carpal mechanics occur. We believe that neutralization of forces early in the course of disease may permit natural healing (revascularization) of the bone. It is questionable whether tubular casts can supply adequate neutralization of force. We recommend the consideration of external fixation, rather than more extensive surgery, as a rational alternative for this purpose. After surgical revascularization, carpal bones go through a resorptive phase that makes them highly susceptible to collapse from compressive forces across the wrist. We advocate the postoperative use of an external fixator to neutralize these forces after a revascularization procedure is performed.