title: Arthroplasty for advanced Kienböck's disease using a radial bone flap with a vascularised wrapping of pronator quadratus.
abstract: We have performed a form of lunate replacement arthroplasty, which included excision of the lunate and insertion of a vascularised radial bone flap wrapped in pronator quadratus, for stage IIIB or stage IV Kienböck's disease, in 41 patients who have been followed up for more than three years. All patients reported an improvement in their symptoms, and 20 of the 41 became free of pain after the operation. Extension and flexion of the wrist were increased by a mean of 9 degrees and 6 degrees , respectively (p < 0.05). The radioscaphoid angle and the carpal height ratio were not significantly changed and only minimal deterioration was observed due to degenerative change. The size, density or location of the inserted bone did not change with time. A vascularised radial bone flap wrapped in pronator quadratus can be a reliable treatment option for advanced Kienböck's disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Gong
authors.forename: M S
authors.initials: MS
authors.lastname: Chung
authors.forename: Y H
authors.initials: YH
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: J O
authors.initials: JO
authors.lastname: Lee
authors.forename: G H
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006801:Humans; D012667:Lunate Bone / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D019637:Orthopedic Procedures / Q000379:methods; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000503:physiopathology; D011859:Radiography; D011884:Radius / Q000637:transplantation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*