This article provides a retrospective follow-up of 15 patients who underwent a Graner procedure for stage III B/IV Kienbock’s disease. This involves excision of the lunate with a capitate osteotomy, followed by proximal transposition of the capitate head to the lunate fossa of the radius and midcarpal fusion. Good results were obtained in 11 patients, fair results in 2 and poor results in 2 patients at over 5 years follow-up. Grip strength returned to 80% at 1 year following surgery. The mean arc of motion was almost the same as it was preoperatively or slightly decreased at follow-up (mean 74 degrees). Fourteen of 15 patients returned to their preoperative job at a mean of 6.7 months. All patients developed degenerative changes at the radiocapitate joint.
This paper provides long term follow-up on a procedure originally described by Graner et al. in 1966. It results in a wrist somewhat equivalent to a four-bone fusion, except the capitate is substituted for the lunate. Unfortunately, the lunate fossa of the radius has a different curvature of radius than the capitate. Furthermore, the procedure does not solve the problem of degenerative changes in the capitate and lunate fossa of the radius. It is most likely these changes that make proximal row carpectomy (and this procedure) somewhat unpredictable when used for late Kienbock’s disease. While this procedure is an option, it may not have much benefit over PRC. A direct comparison of these procedures for Kienbock’s disease would thus be helpful.