The use of vascularized grafts from the distal radius for the treatment of Preiser's disease.
OBJECTIVE
To examine the outcome of vascularized bone grafts (VBGs) used for the treatment of Preiser's disease.


METHODS
Over a 10-year period (1993-2003) 8 pedicled VBGs were performed as the primary treatment for Preiser's disease. All patients had preoperative magnetic resonance imaging (MRI) scans that confirmed the diagnosis of avascular necrosis of the scaphoid. Bone revascularization was evaluated by examining preoperative and postoperative MRIs. All patients had a reverse-flow pedicled VBG from the distal radius. The average patient age was 40 years and the mean follow-up period was 36 months. Postoperative evaluation included range of motion, grip strength, pain evaluation, and Mayo wrist scores.


RESULTS
All MRIs showed evidence of revascularization, with improvement in T2 and/or T1 signal; however, a consistent finding on MRI was incomplete revascularization of the entire proximal pole. Wrist motion averaged 55% of the unaffected side after surgery. Grip strength remained stable. Seven patients had long-term improvement in pain. The average Mayo wrist score was 68, with 1 patient rated as excellent, 1 as good, 5 as fair, and 1 as poor. There was 1 reconstructive failure that resulted in a proximal row carpectomy less than 1 year after the surgery.


CONCLUSIONS
In this series VBGs led to reduced pain levels and preserved the radiocarpal wrist motion in most patients. Inability to revascularize the proximal pole of the scaphoid and ongoing wrist arthritis appear to persist despite revascularization attempts. VBGs for Preiser's disease should be limited to patients with early stage disease (Herbert stages I or II) without evidence of radiocarpal arthritis and no evidence of carpal instability.


METHODS
Therapeutic, Level IV.
Moran
Steven L
SL
Division of Plastic Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Cooney
William P
WP
Shin
Alex Y
AY
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000601:surgery*; D011884:Radius / Q000098:blood supply / Q000637:transplantation*; D021361:Scaphoid Bone