What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Leeuwen, Wouter F. van; Janssen, Stein J.; Meulen, Dirk P. ter; Ring, David

doi:10.1007/s11999-015-4541-1

Cited by 26 publications

(19 citation statements)

References 18 publications

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“…In addition, a significant asymptomatic older population has been identified. 9 The lunate morphology is known to affect the kinematics of the carpus, 10 and predisposes to degeneration of the carpus. 11 The proximal articular "condyle" is the common site of KD.…”

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confidence: 99%

The Etiology and Pathogenesis of Kienböck Disease

et al. 2016

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Kienböck disease is a condition that typically occurs in the "at-risk" patient, in the "atrisk" aspect of the proximal condyle of the "at-risk" lunate. In the active male, repetitive loading causes the stress fracture that commences in the single layer proximal subchondral bone plate. The lunate fracture commences at the point the lunate cantilevers over the edge of the distal radius, and then takes on the shape of the radius. We postulate that the stress fracture violates the parallel veins of the venous subarticular plexus-leading to localized venous hypertension and subsequent ischemia and edema of the fatty marrow. The increased osseous compartment pressure further potentiates the venous obstruction, producing avascular necrosis. If the fracture remains localized, it can heal or settle into a stable configuration, so that the wrist remains functional. Fractures of the subchondral bone plate produce irregularity of the lunate articular surfaces and secondary "kissing lesions" of the lunate facet and capitate, and subsequent degeneration. The lunate collapses when the fracture is comminuted, or there is disruption of the spanning trabeculae or a coronal fracture. The secondary effect of the lunate collapse is proximal migration of the capitate between the volar and dorsal fragments, producing collapse of the entire central column. The proximal carpal row is now unstable, and is similar to scapholunate instability, where the capitate migrates between the scaphoid and lunate. The scaphoid is forced into flexion by the trapezium, however, degeneration of the scaphoid and scaphoid facet only occurs in late disease or following failed surgery. In Kienböck disease, the secondary effects of the collapsing lunate are a "compromised" wrist, including: deformity and collapse of the central column, degeneration of the central column (perilunate) articulations, proximal row instability (i.e., between the central and radial columns), and degeneration of the radial column.

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confidence: 99%

The Etiology and Pathogenesis of Kienböck Disease

et al. 2016

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“…Etiology and natural evolution of Kienbock's disease are largely unknown, 31 and asymptomatic cases are rather frequent. 32,33 Carpal collapse in Kienbock's disease does not progress to radiocarpal osteoarthritis as in posttraumatic cases, 34 probably because there are no abnormal movements between the carpal bones 35 -it is an adaptative carpal collapse, not a carpal instability. 36 Intercarpal arthrodesis (with or without lunate excision) lessen wrist pain but also wrist mobility.…”

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confidence: 99%

Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

2019

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Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion–extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock’s disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.

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“…Personal factors include age and gender, the associated diseases, the trauma-related factors, the social and environmental factors, and the association with osteonecrosis of other carpal bones [2]. Kienböck's disease is classified as rare and its prevalence is about 7 per 100,000 [3,4]. Kienböck's disease shows male predominance, with a peak incidence in patients aged 20-40 years [5].…”

Section: Introductionmentioning

confidence: 99%

Recent Advances in Assessment and Treatment in Kienböck’s Disease

Chojnowski

Opiełka

Piotrowicz

et al. 2022

JCM

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Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

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What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Abstract: Background Kienböck disease is characterized by osteonecrosis of the lunate. Not all patients with radio-

Cited by 26 publications

References 18 publications

The Etiology and Pathogenesis of Kienböck Disease

The Etiology and Pathogenesis of Kienböck Disease

Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases

Recent Advances in Assessment and Treatment in Kienböck’s Disease

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