Kienböks Disease

Abstract

Recent studies on the vascularity of the lunate and the kinematics of the wrist joint have better delineated the pathogenesis of Kienböck's disease. Although the precise cause has not been determined, a natural history of progressive elongation, collapse, and fragmentation has been well delineated. A classification based on the pathogenesis has helped categorize several recently conceived methods of treatment. When the diagnosis of Kienböck's disease is made early, before collapse of the lunate has occurred (stage I or II), ulnar lengthening, radial shortening, or capitate-hamate fusion appears to offer the best chances for revascularization. Presently, for patients with stage III Kienböck's disease, lunate silicone arthroplasty with or without intercarpal fusion appears to provide the best results. Proximal row carpectomy, total wrist arthroplasty, and wrist arthrodesis are reserved for patients with advanced, stage IV Kienböck's disease. Although many of these new techniques for treatment of Kienböck's disease have generated considerable enthusiasm, longer follow-up will be needed to determine whether the distortion of intercarpal relationships can be halted or reversed so that degenerative arthritis of the wrist joint can be prevented. Even if these procedures do not prove to be uniformly satisfactory, the recent application of treatment concepts based on a firmer scientific background has represented a significant step forward in the treatment of Kienböck's disease.