Kienbock's Disease and Scapholunate Dissociation after Acute Wrist Trauma

Abstract

Scapholunate dissociation is well-known to result from acute wrist trauma [9], or in some cases from chronic crystalline synovitis [1, 6]. The etiology of Kienbock’s disease, or osteonecrosis of the lunate bone, remains unclear, and is likely multifactorial. Trauma may be contributory, although variations in lunate and radial morphology, ulnar-negative variance, lunate vascular pattern, disruption of venous outflow, and systemic conditions such as autoimmune disease and sickle cell anemia have all been associated [5, 12]. Both conditions have been studied extensively as independent pathologies, without any defined relationship. We present a case of Kienbock’s disease accompanied by scapholunate dissociation precipitated by a single traumatic event and followed by simultaneous progression. Both conditions have a variety of treatment options and remain controversial, reflecting a lack of prevailing reliably effective and durable surgical procedures, a lack of high-level evidence, and an uncertain natural history [5, 7, 8, 12]. The combination of these conditions presented unique concerns and was ultimately treated successfully with proximal row carpectomy.