Kienbock's disease Discussion

Kienbock's disease is thought to result from interruption of blood supply to the lunate bone with avascular necrosis. Certain people are prone to this if the ulna is shorter than the radius or if there are few vessels supplying the lunate. This situation may be present in both wrists. Kienbock's disease may be staged by appearance on radiographs as follows, with higher numbers indicating a more severe problem:

I Normal

II Lunate sclerosis

III Lunate collapse

IV Carpal arthritis

Management of the early stages of the disease is controversial, for the risk of arthritic progression cannot be predicted. Conservative treatment involves immobilization and anti-inflammatory medication for temporary relief. If significant pain and limitation of motion is present, then consideration can be given to surgery. Surgical options include leveling procedures (either lengthening the ulna or shortening the radius), unloading procedures (shortening the capitate or prolonged distraction fixation), partial or complete wrist fusion. Pain and limitation of motion may continue even after surgery. The risks of these procedures include nonunion, tenderness of the hardware, and obvious failure, among others. Discussion Home Page