The classification and treatment of Kienböck’s disease: the state of the art and a look at the future

The proper treatment of Kienböck’s disease, a disorder that displays slow progression with eventual collapse of the lunate and alteration of the surrounding carpal architecture, requires an understanding of its aetiology and natural history. A reproducible classification system assists the surgeon in making appropriate treatment choices. In this discussion, we review the history and rationale for the four-stage step-wise classification system, along with our current treatment algorithm. We also discuss emerging classification systems and speculate on future directions in treatment and research.

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Update on the Use of Arthroscopy in Kienböck's Disease Management

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0040-1721047 ◽

2020 ◽

Vol 48 (02) ◽

pp. 119-127

Author(s):

René Jorquera Aguilera ◽

Camila Azócar Sanhueza

Keyword(s):

Quality Of Life ◽

Disease Management ◽

Surgical Technique ◽

Functional Outcomes ◽

Treatment Algorithm ◽

Review Of The Literature ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

AbstractKienböck's disease is a clinical-radiological condition that can permanently affect wrist functionality and the patient's quality of life. Proper, pertinent diagnosis and treatment are required to avoid salvage procedures. Arthroscopic techniques have emerged as an important tool for the treatment of certain stages of the disease.We present a review of the literature and propose a treatment algorithm according to the stage of the disease, including arthroscopic techniques. We detail the surgical technique of arthroscopic scaphocapitate arthrodesis, and the functional outcomes obtained by our group.

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Microstructural study of the lunate in stage III Kienböck’s disease with micro-computed tomography imaging

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416664502 ◽

2016 ◽

Vol 42 (1) ◽

pp. 71-77 ◽

Cited By ~ 5

Author(s):

G. Xiong ◽

Z. Xiao ◽

H. Wang ◽

S. Guo ◽

J. Tao

Keyword(s):

Computed Tomography ◽

Trabecular Bone ◽

Bone Structure ◽

Stage Iii ◽

Micro Computed Tomography ◽

Secondary Fracture ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Eventual Collapse ◽

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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RELIABILITY OF LICHTMAN'S CLASSIFICATION FOR KIENBÖCK'S DISEASE IN 99 SUBJECTS

Hand Surgery ◽

10.1142/s0218810411005035 ◽

2011 ◽

Vol 16 (01) ◽

pp. 15-18 ◽

Cited By ~ 3

Author(s):

Masaki Shin ◽

Masahiro Tatebe ◽

Hitoshi Hirata ◽

Shukuki Koh ◽

Takaaki Shinohara

Keyword(s):

Classification System ◽

Wrist Joint ◽

Interobserver Reliability ◽

Clinical Settings ◽

X Rays ◽

New Classification ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Kienbock’S Disease

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease. Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study. Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228). Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

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CLOSING RADIAL WEDGE OSTEOTOMY FOR PREISER'S COMBINED WITH KIENBÖCK'S DISEASE: TWO CASE REPORTS

Hand Surgery ◽

10.1142/s0218810409004189 ◽

2009 ◽

Vol 14 (01) ◽

pp. 57-62 ◽

Cited By ~ 8

Author(s):

Ousuke Hayashi ◽

Takuya Sawaizumi ◽

Hiromoto Ito

Keyword(s):

Avascular Necrosis ◽

Clinical Evaluation ◽

Early Stage ◽

Case Reports ◽

Carpal Bone ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Appropriate Treatment ◽

Kienbock’S Disease

Avascular necrosis involving more than one carpal bone is rare, and the appropriate treatment for this condition has not yet been established. In this report, two patients with concomitant Preiser's and Kienböck's disease who also had severe wrist pain without obvious traumas were treated by closing radial wedge osteotomy (CRWO). Clinical evaluation showed that CRWO was effective against both conditions and indicated that it is more suitable for early stage than stage II diseases of the Hebert and Lichtman classifications.

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