Fluoroscopic visualization of 4+5 extensor compartmental arteries in Kienböck's Disease

Document Type : Original Article


Maltepe University Faculty of Medicine, Orthopedic Surgery Department, Istanbul, Turkiye


Background: Many surgical treatment methods have been presented for Kienböck's disease. The most current treatment method is the surgical procedure with 4+5 extensor compartmental artery (ECA) bone graft. However, the graft harvest site is very close to the radioulnar and radiocarpal joints.
Objectives: This study aimed at determining the efficacy of intraoperative fluoroscopy evaluation of 4+5 ECA.
Methods: Intraoperative fluoroscopic visualization of the 4+5 ECA may facilitate the surgical procedure. Patients with lunate avascular necrosis at stage II-IIIA according to Lichtman classification who underwent 4+5 ECA bone graft were included in the study. A total of 13 patients (3 females, 10 males) participated in the study.
Results: The mean follow-up period of the patients was 15 months. In all patients, 4+5 ECA localizations were determined fluoroscopically. None of the patients experienced complications related to graft harvest.
Conclusion: Locating the intraoperative fluoroscopic 4+5 ECA may make the surgical procedure safer.


Tamer Coşkun [Pubmed] [Google Scholar]



  1. Bain GI, MacLean SB, Yeo CJ, Perilli E, Lichtman DM. The Etiology and Pathogenesis of Kienböck Disease. J Wrist Surg. 2016; 5(4):248-254. doi: 10.1055/s-0036-1583755. Erratum in: J Wrist Surg. 2016;5(4):e1. PMID: 27777813; PMCID: PMC5074830.
  2. Chojnowski K, Opiełka M, Piotrowicz M, Sobocki BK, Napora J, Dąbrowski F, Piotrowski M, Mazurek T. Recent Advances in Assessment and Treatment in Kienböck's Disease. J Clin Med. 2022;11(3):664. doi:10.3390/jcm11030664 PMid:35160115 PMCid:PMC8836398
  3. Camus EJ, Van Overstraeten L. Kienböck's disease in 2021. Orthop Traumatol Surg Res. 2022;108(1S):103161. doi:10.1016/j.otsr.2021.103161 PMid:34861414
  4. Ansari MT, Chouhan D, Gupta V, Jawed A. Kienböck's disease: Where do we stand? J Clin Orthop Trauma. 2020; 11 (4):606-613. doi:10.1016/j.jcot.2020.05.041 PMid:32684697 PMCid:PMC7355093
  5. Rioux-Forker D, Shin AY. Osteonecrosis of the Lunate: Kienböck Disease. J Am Acad Orthop Surg. 2020; 28 (14):570-584. doi:10.5435/JAAOS-D-20-00020 PMid:32692092
  6. Sundberg SB, Linscheid RL. Kienböck's disease. Results of treatment with ulnar lengthening. Clin Orthop Relat Res. 1984; (187):43-51. doi:10.1097/00003086-198407000-00007 PMID: 6744736
  7. van Leeuwen WF, Pong TM, Gottlieb RW, Deml C, Chen N, van der Heijden BEPA. Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome. J Wrist Surg. 2021;10(1):17-22. doi: 10.1055/s-0040-1714750 PMID: 33552689; PMCID: PMC7850797
  8. Almquist EE. Capitate shortening in the treatment of Kienböck's disease. Hand Clin. 1993;9(3):505-12. doi:10.1016/S0749-0712(21)01271-3 PMid:8408261
  9. Shin YH, Kim J, Gong HS, Rhee SH, Cho MJ, Baek GH. Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck's Disease. Clin Orthop Surg. 2017;9(3):355-362. doi:10.4055/cios.2017.9.3.355 PMid:28861204 PMCid:PMC5567032
  10. Lee JH, Kim J, Hwang JS, Baek GH. Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Kienböck's disease. Hand Surg Rehab. 2021;40(5):588-594. doi:10.1016/j.hansur.2021.06.005 PMid:34147670
  11. Illarramendi AA, De Carli P. Radius decompression for treatment of kienböck disease. Tech Hand Up Extreme Surg. 2003;7(3):110-3. doi:10.1097/00130911-200309000-00007 PMid:16518228
  12. Schulz CU. Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis. J Hand Surg Asian Pac. 2019;24(3):276-282. doi:10.1142/S2424835519500346 PMid:31438801
  13. Kirkeby L, von Varfalva Palffy L, Hansen TB. Long-term results after vascularised bone graft as treatment of Kienböck disease. J Plast Surg Hand Surg. 2014;48(1):21-3. doi:10.3109/2000656X.2013.793601 PMid:23731132
  14. Ye X, Feng JT, Yin HW, Qiu YQ, Shen YD, Xu WD. Use of 4+5 extensor compartmental vascularized bone graft and K-wire fixation for treating stage II-IIIA Kienböck's disease. Hand Surg Rehab. 2020;39(3):207-213. doi:10.1016/j.hansur.2020.01.005 PMid:32070791
  15. Moran SL, Cooney WP, Berger RA, Bishop AT, Shin AY. The use of the 4 + 5 extensor compartmental vascularized bone graft for the treatment of Kienböck's disease. J Hand Surg Am. 2005;30(1):50-8 doi:10.1016/j.jhsa.2004.10.002 PMid:15680555
  16. Kakar S, Shin AY. Vascularized bone grafting from the dorsal distal radius for Kienböck's disease: technique, indications and review of the literature. Chir Main. 2010;29 Suppl 1: S104-11. doi:10.1016/j.main.2010.09.003 PMid:21087888