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Capitate transposition to replace necrotic lunate bone with a pedicle for Kienbock's disease: review of 30 cases.

OBJECTIVE
To investigate the clinical application of capitate transposition with a pedicle in 30 cases of Kienbock's disease.


METHODS
The external diameter and curvature of the capitate head and proximal facet of the lunate were observed and measured in 100 specimens. The vascularity of the capitate was also investigated. Capitate transposition with a vascular pedicle was designed to treat 30 patients with advanced Kienbock's disease who were followed up for 2 to 16 years and then analyzed according to Evans's scoring system.


RESULTS
Aseptic necrosis did not occur in the transposed capitate because the pedicle fascia including the dorsal branch of the anterior interosseous artery ensured the vascularity of proximal two thirds of the capitate. The transposed capitate reestablished a relatively pain-free radiocarpal joint. Follow-up results showed that grip strength and motion arc were up to 70% of contralateral side.


CONCLUSIONS
Capitate transposition with a pedicle is a reliable treatment method for advanced Kienbock's disease, with favorable prognosis for at least five years postoperatively.