Vascularized bone transfer for the treatment of advanced-stage juvenile lunatomalacia: a report of two cases.

We present the first two cases of juvenile patients, with advanced-stage lunatomalacia (Lichtman stage IIIB) in the literature, who were successfully treated with vascularized bone transfers. A corticoperiosteal metacarpal II bone graft was used in both patients, accompanied by an external monorail fixateur that was mounted for 6 weeks to achieve temporary wrist distraction. At 1-year follow-up, the patients had no residual pain, full wrist range of motion, and proper radiologic remodeling of the collapsed lunate. Surgically diminished compression forces at wrist level, temporary gain of joint width, as well as high juvenile potential for remodeling might have enhanced lunate revascularization.