![]() The condition is named after Austrian radiologist Robert Kienböck (1871-1953), who described the condition in 1910 4.Diabetes mellitus (DM) and periodontitis are very common and they interact with each other bidirectionally. Proximal row carpectomy is used as a salvage procedure in refractory cases 1. Other operative procedures include ulnar lengthening, revascularization, lunate excision with or without prosthetic replacement, and intercarpal fusion. Radial shortening to correct negative ulnar variance is the most common surgical therapy with good results. Treatment and prognosisĬonservative management with rest, non-steroidal anti-inflammatory drugs, and immobilization in mild cases is often very effective. Negative bone scintigraphy can be useful to exclude the disease, however, a positive scan is not specific enough for the diagnosis. Bone edema (high T2, intermediate T1) may be seen in the acute phase, particularly on the radial side. Sclerosis (low T1 and T2) is usually seen centrally and within the radial aspect of the lunate. The pattern of lunate bone signal change allows the condition to be differentiated from ulnar impaction syndrome: the major differential diagnosis. Is the most sensitive and specific test and may detect very early disease. Fragmentation of the lunate and secondary degenerative disease may develop later. When flattening is marked there is rotation of the scaphoid which further adds to the stress on the lunate. See article Stahl classification of Kienböck disease (modified by Lichtman) 5. ClassificationĪ five-stage radiographic classification system exists. In the remaining ~30%, only a single vessel is present volar and dorsally, which predisposes to osteonecrosis of the lunate 1. On the dorsal surface, dorsal perforating branches of the anterior interosseous artery are seen in 86% of patients and dorsal branch from the dorsal intercarpal arch in 50% of patients 3. ![]() On the volar surface, these include branches from the anterior interosseous artery in 70% and a branch of the palmar intercarpal arch in 70% of patients. In 70% of patients, multiple vessels supply both volar and dorsally. The vascular supply of the lunate greatly contributes to formation of Kienbock disease. Microfractures ensue resulting in flattening and deformity of the bone surface. There is disruption of critical blood supply leading to bone infarction, central necrosis, and surrounding hyperemia. The pathologic changes are equivalent to those of osteonecrosis of other bones. Overall, the negative ulnar variance is present as a predisposing factor in around 75% of cases of Kienbock disease. A causal association is difficult to prove, however, the effectiveness of decompressive procedures such as radial shortening or ulnar lengthening in relieving pain and preventing further collapse of the lunate is supportive 2. There is a significant association between negative ulnar variance and Kienbock disease, although the majority of people with negative ulnar variance do not have the condition. In women, Kienböck disease typically occurs in middle age and is equally divided between the dominant and non-dominant wrist 1. The condition is most common within the dominant wrist of young adult men where it appears to be due to repeated loading of the lunate. The age distribution for Kienböck disease depends on gender.
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