Vascularized Capitate Transposition for Advanced Kienb??ck Disease

In Brief Based on anatomic study, the vascularized capitate transposition to replace excised necrotic lunate was designed and applied in 40 cases of advanced Kienböck disease. It includes excision of the necrotic lunate and proximal shift of the vascularized capitate. The blood supply of the transposed capitate is provided by the dorsal branch of the anterior interosseous artery. Bone union occurred radiographically, and no postoperative capitate necrosis occurred in all cases after 6 weeks. Twenty-three cases were followed up for 1 year. No residual wrist pain existed in the range of motion, but limited residual wrist pain existed in labor work. The arc of motion ranged on average from 35 degrees of flexion to 45 degrees of extension. The grip power of the affected hand reached on average 70% compared with the contralateral. The authors conclude the vascularized capitate transposition is a reliable alternative for advanced Kienböck disease. Forty cases of advanced Kienböck disease were treated with lunate excision and proximal shift of the vascularized capitate. Bony union was achieved in all cases, with improvement in pain, range of motion, and grip strength.