Vascularized Bone Graft in Kienbock's Disease Based on a Pronator Quadratus Muscle Pedicle

Treatments of Kienböck's disease range from conservative measures to various surgical procedures, according to the progression of the disease. In this report, the authors reviewed and analyzed patients treated with a pronator quadratus muscle pedicled (PQMP) bone graft for Kienböck's disease and reported the results of this procedure.

Fifteen patients were treated with PQMP bone graft. The mean follow-up period was 5.4 (1.2–14.1) years. Of the 15 patients, 12 were men and 3 women, with a mean age of 43.3 (19–59) years. Four patients had a history of trauma, and 11 involvements occurred in the dominant hands. The authors assessed subjective pain, and radiographic finding such as Lichtman's stages, and carpal height ratio in the preoperative, postoperative, and last follow-up, and analyzed range of motion of the wrist, and grip and pinch power measured by the Jamar Dynamometer, compared to the contralateral side. In the preoperative radiologic stages of Lichtman, five patients had stage II and 10 patients stage IIIA. Average carpal height ratio was 0.55 (0.52–0.59) preoperatively.

All patients had a painless wrist and expressed satisfaction with the outcome of this procedure. All patients returned to their original jobs or avocations. Eleven of 15 patients used their wrists without difficulty. The remaining 6 patients had some difficulty in daily working, but not in the activities of daily living. At the last follow-up, the radiologic stages were as follows: stage II, 4 cases; stage IIIA, 8 cases; stage IIIB, 3 cases. In the radiologic stages, four cases had deteriorated at last follow-up. The mean carpal height ratio was 0.52 preoperatively and 0.54 (0.44–0.58) postoperatively. The average range of wrist motion, compared with that before operation, was increased slightly in all planes. The average palmar flexion was 56 degrees, an average increase of 11 degrees, compared with the average preoperative palmar flexion. The average dorsiflexion was 53 degrees, an average increase of 11 degrees. The average ulnar deviation was 31 degrees, an average increase of 10 degrees. And the radial deviation was 17 degrees, an average increase of 6 degrees. The average grip and pinch strength on the affected side were 74% and 83% of that on the contrlateral side, an average improvement of 33% and 36%.

PQMP bone graft is an effective treatment for Kienböck's disease with stages II or IIIA in the wrists, because pain relief, preserving range of motion of the wrist, with a short period of immobilization, and preventing the progression of this disease can be expected.