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Kienbock's disease DiscussionKienbock'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
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American Society for Surgery of the Hand assh.org The Best Resource For Your Hands, Period. |