Callus distraction for progressive lengthening of the capitate bone after resection of the lunate bone in stage III lunate malacia. Surgical technique and 1 year results

: Inspite of the excellent subjective judgement and functional results of Graner's operation in case of Kienbock's disease stage III, this technique is rarely used nowadays because of its high rate (20 to 30%) of disturbed fracture healing due to impaired blood supply. To avoid the risk of complete devascularization in the capitate region, we are using the callotaxis lengthening technique of Ilizaron, carrying out a segmental shifting. After percutaneous temporary SC- or STT-arthrodesis with the scaphoid in the horizontal or high position, the lunate is completely resected using a dorsal approach. Osteotomy of the capitate is carried out at the corpus-collum interval in order to disturb a minimum of the vascular supply to the bone. Seven to ten days postoperatively, distraction is started with a rate of 1 min/day. The desired distraction length is accomplished, when the capitate articular surface fits perfectly into the curvature of the proximal row articular surface. In order to reduce or prevent soft tissue related complications during the consolidation period, the external distractor is replaced by two percutaneous Kirschner-wires. The consolidation period takes twice as long as the distraction period. Since November 1993, fourteen patients presenting a stage III Kienbock's disease have been treated by this new technique. The operative technique, postoperative care, as well as the potential and real complications are described and illustrated by one clinical case.