Effects of Core Decompression and Local Deferoxamine Injection on Clinical Outcomes and Revascularization of Lunate Carpal Bone in Kienböck‎ Disease: A Pilot Study

Background: Avascular necrosis of the lunate or Kienböck disease is a rare disorder with unknown etiology and challenging treatment. Objectives: In this study, we evaluated the effects of local deferoxamine injection as an angiogenic molecule and core decompression to treat Kienböck disease. Methods: In a pilot clinical trial, 8 patients with stage I to IIIA of Kienböck disease were treated with core decompression and local deferoxamine injection (0.5 mL 500 mg/mL). The outcome measures included wrist range of motions, pinch and grip strength, patient-rated wrist/hand evaluation (PRWE), a short form of disabilities of the arm, shoulder, and hand (Quick-DASH), and visual analog scale (VAS) for pain. The assessment of lunate revascularization was also done by T1- and T2-weighted magnetic resonance imaging. All measurements were done before the intervention and 3, 6, and 12 months after the intervention. Results: Wrist flexion, extension, ulnar and radial deviation, and pinch and grip strength were continuously improved over the postoperative periods. These improvements were statistically significant. The mean final pinch and grip strength averaged 87.4% and 72.8% of the noninvolved hand, respectively. PRWE, Quick-DASH, and VAS scores were also continuously and significantly improved over the study period. The lunate vascularization revealed a continuous improvement in 6(75%) patients. Conclusion: Local deferoxamine injection in addition to core decompression could improve the radiologic and clinical outcomes of patients suffering from Kienböck disease.