Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

Cover Page


Relevance. For more than a century, many methods of treating Kienböck’s disease have been developed, although none of them could achieve consistently good results. The transposition of the pisiform into the lunate location after removal of the latter, as well as the combination of this operation with a shortening osteotomy of the radius, is considered as one of the promising methods of this disease treatment. The purpose of this publication was to demonstrate the options of the modern reconstructive surgery for the treatment the stage IIIb Kienböck’s disease. Case presentation. A clinical case of a successful non-free transplant of a blood-supplied pisiform in aseptic necrosis of the lunate is described. A patient was a 21 year old military serviceman with stage IIIb Kienböck’s disease complicated by persistent pain syndrome and severe dysfunction of the left wrist. He underwent removing the fragmented lunate with replacing it with a pisiform on the tendon feeding pedicle and performing simultaneous shortening osteotomy of the radius. The displaced bone was fixed with an anchor to the dorsal surface of the distal radial metaepiphysis. In 12 months after the surgery, an improvement of the wrist function was achieved in the form of an increase in the range of motion compared with the preoperative period and a significant decrease in the level of pain syndrome. The radiological examination at the same time showed the preservation of the shape, size and intraarticular localization of the bone autograft. Conclusion. The use of transposition of the blood-supplied pisiform on a permanent tendon feeding pedicle into the region of the removed lunate demonstrated, in our opinion, the favorable possibilities of successful surgical treatment of the late stages of Kienböck’s disease. A favorable outcome of such treatment is possible only in a specialized hospital, where there are trained specialists in the field of hand surgery, and there are also opportunities for employment a modern rehabilitation complex aimed at restoring movements in the hand joints, taking into account the strength and coordination parameters of its anatomical structures.

About the authors

V. V. Khominets

Kirov Military Medical Academy

ORCID iD: 0000-0001-9391-3316

Vladimir V. Khominets — Dr. Sci. (Med.), Head of Department of Military Traumatology and Orthopedic

St. Petersburg

Russian Federation

M. V. Tkachenko

Kirov Military Medical Academy

Author for correspondence.
ORCID iD: 0000-0001-6034-7047

Maksim V. Tkachenko — Cand. Sci. (Med.), Senior Lecturer

St. Petersburg

Russian Federation

V. S. Ivanov

Kirov Military Medical Academy

ORCID iD: 0000-0001-5414-7559

Vitaliy S. Ivanov — Senior Clinic Resident

St. Petersburg

Russian Federation

D. Yu. Muhkurya

Kirov Military Medical Academy

ORCID iD: 0000-0003-1058-8031

Dmitriy Yu. Muhkurya — Orthopedic Surgeon

St. Petersburg

Russian Federation


  1. Peste J.L. Discussion. Bull Soc Anat. 1843; 18. p. 169.
  2. Speed K. A textbook of fractures and dislocations. Philadelphia: Lea & Febiger, 1916. p. 826.
  3. Fontaine C. Kienböck’s disease. Chir Main. 2015;34(1):4-17. doi: 10.1016/j.main.2014.10.149.
  4. van Leeuwen W.F., Tarabochia M.A., Schuurman A.H., Chen N., Ring D.. Risk Factors of Lunate Collapse in Kienböck Disease. J Hand Surg Am. 2017;42(11):883-888. e1. doi: 10.1016/j.jhsa.2017.06.107.
  5. Lichtman D.M., Pientka W.F., Bain G.I. Kienböck Disease: A New Algorithm for the 21st Century, Special Review. Wrist Surg. 2017;6(1):2-10. doi: 10.1055/s-0036-1593734.
  6. Tahta M., Ozcan C., yildiz G., Gunal I., Sener M. Lunate excision with capitohamate fusion in the treatment of stage IIIB and IIIC Kienbock’s disease. Acta Orthop Traumatol Turc. 2018;52(3):211-215. doi: 10.1016/j.aott.2018.02.004.
  7. Shin y.H., Kim J., Gong H.S., Rhee S.H., Cho M.J., Baek G.H. Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck’s Disease. Clin Orthop Surg. 2017;9(3):355-362. doi: 10.4055/cios.2017.9.3.355.
  8. Barrera-Ochoa S., Campillo-Recio D., Muñoz-Perdomo T., Esteban-Feliu I., Mendez-Sanchez G., Mir-Bullo x. Dorsolateral Biplane Closing Radial Osteotomy and Lunate Fixation for Stage IIIC Kienböck Disease: A New Surgical Approach. Tech Hand Up Extrem Surg. 2018;22(3):74-80. doi: 10.1097/BTH.0000000000000197.
  9. Chevrollier J., Pomares G., Huguet S., Dap F., Dautel G. Intracarpal shortening osteotomy for Kienböck’s disease: A retrospective study of 28 cases. Orthop Traumatol Surg Res. 2017;103(2):191-198. doi: 10.1016/j.otsr.2016.12.016.
  10. Camus E.J., Van Overstraeten L. Evaluation of Kienböck’s Disease Treated by Camembert Osteotomy at Seven years. J Wrist Surg. 2019;8(3):226-233. doi: 10.1055/s-0039-1683931.
  11. Viljakka T., Tallroth K., Vastamäki M. Long-Term Clinical Outcome After Titanium Lunate Arthroplasty for Kienböck Disease. J Hand Surg Am. 2018;43(10):945. e1-945.e10. doi: 10.1016/j.jhsa.2018.02.009.
  12. Tahta M., Zengin E.C., Ozturk T., Mete B.D., Gunal İ., Sener M. Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: MidTerm Results. Plast Surg (Oakv). 2019;27(2):141-146. doi: 10.1177/2292550319828787.
  13. Ho Shin y., yoon J.O., Ryu J.J., Lee T.K., Choi S.W., Kwang Kim J. Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years. J Hand Surg Eur Vol. 2020;45(4):396-402. doi: 10.1177/1753193419836628.
  14. Shin y.H., Kim J.K., Han M., Lee T.K., yoon J.O. Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review. J Bone Joint Surg Am. 2018;100(14):1231-1240. doi: 10.2106/JBJS.17.00764.
  15. Marcuzzi A., Colantonio F., Petrella G., Ozben H., Russomando A. Stage IV Kienböck’s disease: Proximal row carpectomy and application of RCPI implant. Hand Surg Rehabil. 2017;36(2):102-108. doi: 10.1016/j.hansur.2016.12.005.
  16. Tsantes A.G., Papadopoulos D.V., Gelalis I.D., Vekris M.D., Pakos E.E., Korompilias A.V. The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients. J Hand Microsurg. 2019; 11(1):6-13. doi: 10.1055/s-0038-1677318.
  17. Higgins J.P., Bürger H.K. The use of osteochondral flaps in the treatment of carpal disorders. J Hand Surg Eur Vol. 2018;43(1):48-56. doi: 10.1177/1753193417739545.
  18. Lee S.K., Kim K.J., Shin H.S., Choy W.S. Treatment of Advanced Kienböck Disease With a Vascularized Radial Bone Flap Wrapped in the Pronator Quadratus. Ann Plast Surg. 2017;78(3):274-279. doi: 10.1097/SAP.0000000000000937.
  19. Lichtman D.M., Mack G.R., MacDonald R.I., Gunther S.F., Wilson J.N. Kienböck’s disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am. 1977;59(7):899-908.
  20. Stahl F. On lunatomalacia (Kienbock’s disease): a clinical and roentgenological study, especially on its pathogenesis and the late results of immobilization treatment. Lund, Ohlsson; 1947. p. 1-133.
  21. Shin y.H., Kim J., Gong H.S., Rhee S.H., Cho M.J., Baek G.H. Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck’s Disease. Clin Orthop Surg. 2017;9(3):355-362. doi: 10.4055/cios.2017.9.3.355.
  22. Tan Z., xiang Z., Huang F., yang Z., xiao C., Duan x. Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years: A case series. Medicine (Baltimore). 2018;97(48):e13229. doi: 10.1097/MD.0000000000013229.
  23. Daecke W., Lorenz S., Wieloch P., Jung M., Martini A.K. Vascularized os pisiform for reinforcement of the lunate in Kienbock’s Disease: an average of 12 years of follow-up study. J Hand Surg Am. 2005;30(5): 915-922. doi: 10.1016/j.jhsa.2005.03.019.
  24. Saffar P. Vascularized pisiform transfer in place of lunatum for Kienbock’s Disease. J Chir Main. 2010;29 Suppl 1:S112-S118. doi: 10.1016/j.main.2010.09.005.
  25. Innes L., Strauch R.J. Systematic review of the treatment of Kienböck’s disease in its early and late stages. J Hand Surg Am. 2010;35(5):713-717.e7174. doi: 10.1016/j.jhsa.2010.02.002.
  26. Becker C., Gilbert A. Le lambeau antebrachial des branches distales de l’artere cubitale. Monographies du Groupe d’Etudes de la Main. T. 17. Paris : Expansion Scientifique Francaise ; 1990. p. 102-106.



Abstract: 593


Article Metrics

Metrics Loading ...


Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies