The use of coronal computed tomography in the evaluation of Kienbock's disease

Seventeen fresh lunates with stage III Kienböck’s disease were scanned with micro-computed tomography. Four regions of interest were selected to measure trabecular parameters, which were compared with those from normal lunates. Within the three regions in the distal surface, there was more compact trabecular bone in the middle region when compared with the palmar and dorsal regions. In the central part, the trabeculae of the Kienböck’s lunates were much thicker than those in normal lunates. The diameters of the palmar nutrient foramina of the Kienböck’s lunates were significantly smaller than those in normal lunates. In affected lunates, the bony disruptions were mostly located in the palmar or dorsal areas, which were shown from trabecular bone structure analysis to be structurally weaker. This leads to separation of the distal part of the fractured bone, disruption of the blood supply, poor bone remodelling and proneness to secondary fracture and eventual collapse.

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Kinematics of the wrist in Kienböck’s disease: a four-dimensional computed tomography study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420987790 ◽

2021 ◽

pp. 175319342098779

Author(s):

Simon B. M. MacLean ◽

Gregory I. Bain

Keyword(s):

Computed Tomography ◽

Ct Scanning ◽

Ulnar Styloid ◽

Level Of Evidence ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Internal Instability ◽

Fracture Types ◽

Midcarpal Joint ◽

Kienbock’S Disease

We studied the kinematics of 20 wrists affected by Kienböck’s disease using four-dimensional computed tomography (4-D-CT) scanning. Degenerative changes progressed from the lunate facet to the scaphoid fossa at the radiocarpal articulation, then involved the midcarpal joint. Lunate fracture types included coronal (14/20), sagittal (10/20) and ligament attachment-types (8/20). Findings specific to dynamic scanning included the nutcracker phenomenon (12/20), anterior radiolunate impingement (7/20), internal instability of the lunate (6/20), ulnar styloid triquetral impingement (3/20) and dynamic proximal row instability (2/20). Ulnocarpal translocation was found in 4/20 cases. Dynamic 4-D-CT has helped us to identify a subset of pathology in Kienböck’s disease on assessment of static imaging. Better understanding of these phenomena can improve our understanding of symptoms and may help direct surgical treatment. Level of evidence: IV

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Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?

Journal of Wrist Surgery ◽

10.1055/s-0039-1688993 ◽

2019 ◽

Vol 09 (01) ◽

pp. 039-043

Author(s):

Arvind Mohan ◽

Richard Knight ◽

Hiba Ismail ◽

Ian A. Trail

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Ulnar Variance ◽

Height Ratio ◽

Carpal Collapse ◽

Kienböck’S Disease ◽

X Ray ◽

Kienböck's Disease ◽

Carpal Height ◽

Kienbock’S Disease

AbstractCarpal height ratio and ulnar variance on plain X-ray were measured and compared to the width/height ratio of the lunate as measured on a computed tomography (CT) scan in 50 patients with Kienböck's disease. Width/height ratio of the lunate was also measured in a series of 50 controls. No correlation between ulnar variance and fractures was found. Conversely, the correlation between carpal height ratio on X-ray and width/height ratio on a CT scan was statistically significant. Similarly, the correlation between ulnar variance and width/height ratio was statistically significant. We have concluded that width/height ratio while correlating with carpal height is a better measure of lunate collapse. It also appeared that lunate collapse precedes carpal collapse, specifically most if not all lunates have collapsed prior to reduction in carpal height ratio. Finally, while we are unable to conclude the level at which the width/height ratio of lunate becomes unreconstructable, it does appear that in all Litchman stage 3b and most if not all of 3a the shape of the lunate has altered significantly.

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