Management of early-stage Kienböck disease (stages 1–3a) with vascularized bone grafting

Aims: Kienböck’s disease is characterized by avascular necrosis of the lunate, with its etiology still debated. Vascularized bone grafting (VBG) has emerged as a surgical option for early-stage disease to improve vascularity and preserve carpal function. This study aimed to evaluate clinical and functional outcomes of stage 1–3A Kienböck’s disease treated with a pedicled VBG based on the 4th and 5th extensor compartment arteries (ECAs). Methods: This retrospective cohort included 22 patients (7 stage 1, 9 stage 2, 6 stage 3A) treated between 2017 and 2023. Surgical technique involved harvesting a corticospongious graft from the distal radius, transferred on the 4+5 ECA pedicle into the lunate defect. Postoperatively, a short-arm splint was applied for 4–6 weeks, followed by physiotherapy. Outcomes were assessed preoperatively and at 12 months: wrist flexion–extension arc, ulnar–radial deviation, grip strength, Visual Analog Scale (VAS, 0–100), and QuickDASH. Paired comparisons were performed with the paired T-test or Wilcoxon signed-rank test; comparisons among disease stages (stage 1, stage 2, and stage 3A) were performed using the Kruskal–Wallis test. Results: At one year, patients demonstrated significant improvements: flexion–extension arc (90.05°→128.00°, p