Kienbock, Preiser-Procedural Library: Vascularized Bone Graft: Use of the 4-5 ECA Distal Radius Graft

Procedural Library: Vascularized Bone Graft: Use of the 4-5 ECA Distal Radius Graft

Video Transcription

Video Summary

Summary:<br /><br />The video discusses the selection of appropriate treatment for Keenbox disease, which remains a challenge for clinicians. While current treatment options focus on altering mechanical load, another method is to directly revascularize the lunate, addressing the underlying issue. Vascularized bone grafts and arteriovenous pedicles have been used for this purpose. The preferred approach involves using dorsal radius grafts obtained via a dorsal incision. The video describes the anatomy and dissection process involved in revascularization. A high-speed burr is used to remove necrotic bone from the lunate, followed by graft placement centered over the fourth extensor compartment artery pedicle. The graft is elevated using osteotomes, ensuring it contains both cortical and cancellous bone. It is then placed vertically into the lunate, filling the previously burred and curetted defect. Temporary unloading with Kirschner wires and postoperative management are also discussed. Vascularized bone grafting from the dorsal distal radius is presented as an alternative treatment option for Keenbox disease.

Keywords

Keenbox disease

treatment selection

revascularization

vascularized bone grafts

dorsal radius grafts