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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 5,
623-628.
doi: 10.1302/0301-620X.88B5.16888 Copyright © 2006 by British Editorial Society of Bone and Joint Surgery Arthroplasty for advanced Kienböcks disease using a radial bone flap with a vascularised wrapping of pronator quadratusH. S. Gong, MD, Assistant Professor, Orthopaedic Surgeon1; M. S. Chung, MD, PhD, Professor, Orthopaedic Surgeon1; Y. H. Lee, MD, PhD, Assistant Professor, Orthopaedic Surgeon1; S. Lee, MD, Fellow, Hand Division of Orthopaedic Department1; J. O. Lee, MD, Orthopaedic Resident1; and G. H. Baek, MD, PhD, Professor, Orthopaedic Surgeon11 Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. Correspondence should be sent to Professor G. H. Baek; e-mail: ghbaek{at}snu.ac.kr
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 Kienböcks 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° and 6°, 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 Kienböcks disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
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