title: Treatment of Kienböck's disease using a fourth extensor compartmental artery as a vascularized pedicle bone graft.
abstract: BACKGROUND
  Vascularized bone grafts for the treatment of Kienböck's disease may facilitate revascularization and remodeling of the avascular lunate. The aim of this study was to evaluate the radiological and clinical results obtained when a fourth extensor compartmental artery (ECA) bone graft was used to treat Kienböck's disease.
  
  
  METHODS
  Between May 2009 and June 2012, 13 patients (6 men, 7 women) with Kienböck's disease were treated with placement of fourth ECA vascularized bone grafts. The mean patient age was 39.2 (20-58) years, and the mean follow-up period was 32.5 (12-72) months. At the time of surgery, One patient had Lichtman's stage II Kienböck's disease, 11 stage IIIA disease, and one stage IIIB disease. We measured the pre- and post-operative ranges of motion, pain, grip strength, and radiological parameters, including the carpal height ratio and the radioscaphoid angle.
  
  
  RESULTS
  At the last follow-up, pain was significantly reduced, and grip strength had improved from 60.5% to 87.8% relative to that of the contralateral side. The mean range of motion for flexion had improved from 39° to 53° while that of wrist joint extension improved from 41° to 56°. There were little or no changes in either the carpal height ratio or the radioscaphoid angle (both p values > 0.05).
  
  
  CONCLUSIONS
  Placing of a fourth ECA vascularized bone graft is a reliable alternative to other revascularization procedures for treatment of Kienböck's disease. Such grafting is effective, minimally invasive, and associated with a low risk of pedicle kinking.
  
  
  METHODS
  Therapeutic/IV.
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Il-Jung
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 47007, Republic of Korea.
authors.forename: Hyoung-Min
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Youn-Tae
authors.initials: YT
authors.lastname: Roh
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Do-Yeol
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Neung-Han
authors.initials: NH
authors.lastname: Jeon
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, St. Paul's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Yong-Deok
authors.initials: YD
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, St. Paul's Hospital, The Catholic University of Korea, Republic of Korea. Electronic address: gamjang@medimail.co.kr.
authors.forename: Soo-Hwan
authors.initials: SH
authors.lastname: Kang
mesh_terms: D000328:Adult; D016723:Bone Remodeling; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D012667:Lunate Bone / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular; D020127:Recovery of Function; D056910:Republic of Korea; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology
keywords: Fourth extensor compartmental artery; Kienböck's disease; Lunate; Vascularized bone graft