Avascular necrosis of the carpal bones

Abstract

Avascular necrosis of the carpus is an important cause of wrist pain, limited motion, and weakness. The end result of these conditions is often arthritis. Surgical options are varied and successful treatment can be challenging. This article includes a general review of the current indications and treatments for these problems.

New literature has focused on better establishing the role of vascularized bone grafts in the management of osteonecrosis of the lunate and scaphoid. Although many reports of vascularized bone grafts for avascular necrosis of the carpus are encouraging, some reports have been less favorable, particularly, in the treatment of proximal pole avascular necrosis associated with scaphoid nonunion and humpback deformity. Newer grafting techniques have attempted to utilize free transfer of structural bone graft from the distal femoral condyles. In treating Kienböck disease, vascularized capitate transfers, distraction osteogenesis for ulnar lengthening, and comparison of partial wrist arthrodesis and radial osteotomy recently have been reported. Preiser disease remains a challenge. New reports of vascularized bone grafts for this condition have suggested some guarded optimism.

Treatment of avascular necrosis of the carpus continues to evolve. Vascularized bone grafting continues to play a significant role in treatment. New techniques of unloading procedures and comparison studies of established techniques also highlight the recent literature.