kienböck disease (lunatomalacia)bonepit.com/lectures/kienbock orrin franko.pdf · kienböck...
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Kienböck Disease(Lunatomalacia)
Orrin Franko, M.D.
R1 - Resident Physician
UC San Diego Medical Center
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Kienböck Disease
►Avascular necrosis of lunate
►Unknown cause Men; age 20-40
Dominant hand
Unilateral
Manual labor
75% preceded by trauma
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Etiology
►Microfractures vascular compromise
►Repetitive compressive loading
►Compression of lunate
Between capitate and distal radius
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Risk Factors
►Negative ulnar variance
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Clinical Manifestations
►Wrist pain forearm
►Stiffness, tenderness, swelling over lunate
►Pain with passive dorsiflexion of middle finger
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Radiographic Findings
►Sclerosis of lunate
May include negative ulnar variance
►Loss of height fragmentation
►Further collapse carpal instability
Degenerative joint changes, lunate cysts
►Involvement of entire wrist
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Classification► Lichtman’s Radiographic
Classification Stage 1: Normal architecture,
evidence of linear or compression fracture
Stage 2: Definite density changes in lunate
Stage 3: Collapse of lunate
► 3A: Without fixed scaphoid rotation
► 3B: With fixed scaphoid rotation
Stage 4: Generalized degenerative changes in carpus
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Stage 1
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Stage 2
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Stage 3
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Stage 4
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“Broken Canoe” Sign
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Radiographic Diagnosis
► Primary: plain film
►MR yet undefined role
Well-established for osteonecrosis
Coronal slices
Classify pattern and extent of damage
T1 spin echo
►Focal loss of signal involving radial half of lunate
►Diffuse loss of signal over entire lunate
T2 spin echo
►Variable
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Unknown Age/Sex
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21 yo M
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46 yo F
46F
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46F
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46F
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46F
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Operative Treatment
►Ulnar lengthening / radial shortening
►Proximal row carpectomy
►Lunate replacement
►Lunate revascularization
►Arthrodesis
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Acknowledgements
►Dr. Tudor Hughes