Lichtman DM, Alexander AH, Mack GR, Gunther SF. Kienbock’s disease: The role of silicone replacement arthroplasty. J Bone Joint Surg Am ; Antuña Zapico JM. Enfermedad de Kienbock. Rev. t ; 37 IB ( Supl.I): Antuña Zapico JM. Malacia del Semilunar. Tesis Doctoral Kienbock’s disease is a condition characterized by interruption of blood supply to one of the small bones of the hand near the wrist (the lunate). If blood supply to.
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The four corner fusion is a good surgical option for late scapholunate advanced collapse SLAC wrist disease, as it bypasses the enrermedad radial column and mobilizes the wrist through the stabilized the central column.
HPI – Condition started 6 months ago with minor trauma to right hand after falling. He has plans to work as a police officer. In very late disease or failed surgery, the radiolunate articulation is compromised, in which case a salvage procedure is required. Traumat ; 37 IB Supl. L6 – years in practice. Analogy with Scapholunate Instability As noted there are several similarities between KD and scapholunate instability.
Avascular necrosis of the lunate leading to abnormal carpal motion Epidemiology incidence most common in males between years old risk factors history of trauma Pathophysiology thought to be caused by multiple factors biomechanical factors ulnar negative variance leads to increased radial-lunate contact stress decreased radial inclination repetitive trauma anatomic factors geometry of lunate vascular supply to lunate patterns of arterial blood supply have differential incidences of AVN disruption of venous outflow leading to increased intraosseous pressure Prognosis progressive and potentially debilitating condition if unrecognized and untreated.
The Etiology and Pathogenesis of Kienböck Disease
Note that most of the cortex is still present but fragmented. Jensen hypothesized this impairment in venous outflow may be a factor in the development of KD. Conflict of Interest None. Fractures of the lunate subchondral bone plate produce irregularity of the lunate articular surface. As noted there are several similarities between KD and scapholunate instability.
The scaphoid is forced into flexion by the trapezium, however, degeneration of the scaphoid and scaphoid facet dr occurs in late disease or following failed surgery.
Radial shortening of 4mm.
Avascular necrosis of the lunate and sickle cell kienbocl. However, all of these aspects are interrelated, and vary with time. Taniguchi Y, Tamaki T.
Universidad de Valladolid, Servicio de Publicaciones; Crock studied the venous osseous drainage of the lunate, describing the extraosseous veins accompany the arteries.
Bone edema and hyperemia can be identified on gadolinium-enhanced magnetic resonance imaging MRI and osteoblastic activity can be seen on a single-photon emission computed tomography SPECT scan Fig. Support Center Support Center.
REVISTA PATOLOGÍA DEL APARATO LOCOMOTOR
kinebock Idiopathic necrosis of the femoral head: Despite this, the patient continues to complain of weakness, stiffness, and pain with exertion of right hand. Lille Chirurgicale ; 2: In the above paragraphs we have separated the various aspects df KD, and how it affects the lunate and the wrist.
C and D Note the changes on the MRI, including the edema of the volar ligaments at the lunotriquetral articulation white arrow. In the active male, repetitive loading causes the stress fracture that commences in the single layer proximal subchondral bone plate.
Kienbock’s Disease – Hand – Orthobullets
A typical disease of the upper femoral epiphysis Reprinted in Clinical Orthopaedics ; A case series of nine patients and review of literature. Excision of the lunate was performed with postoperative immobilization for one month. Hand Surg ; 28 A, Clinical Orthopaedics ; Proximal Row Instability Proximal row instability is due to disruption of the linkage between the enfrmedad columns.
L8 – 10 years in practice.
Hand Surg ; 29A, As emphasized above with SLAC wrist disease, there is progression from dynamic, to static, and then fixed deformity. The lunate morphology is known to affect the kinematics of the carpus, 10 and predisposes to degeneration of the carpus. The articular surfaces are enfermead interfaces that allow motion and transmit the load from their column.
Hand Surg ; Advances in Diagnosis and Treatment. Image courtesy of Crock AO.
With loss of height of the central column, the trapezium forces the scaphoid into flexion, thereby compromising the radial column. Which of the following imaging studies would be most sensitive for determining the stage of this patient’s underlying condition?
Open in a separate window. The fracture, typically involves the radial half of the lunate and only in the most extensive cases does it involve the ulnar side Fig.