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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Crock studied the venous osseous drainage of the lunate, describing the extraosseous veins accompany the arteries. National Center for Biotechnology InformationU.

Kienbock’s Disease – Hand – Orthobullets

Hand Surg ; 29A, The SPECT scan demonstrates increased uptake within the lunate due to new bone formation and remodeling within the lunate. The scaphoid is forced into flexion enfermedae the trapezium, however, degeneration of the scaphoid and scaphoid facet only occurs in late disease or following failed fnfermedad.

Proximal row instability is due to disruption of the linkage between the three columns. Image courtesy of Crock AO. SPECT, single-photon emission computed tomography.

Several morphological factors are associated with the condition; all of which increase loading on the radial aspect of the lunate Fig.

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We believe this is in part related to the venous hypertension. Published online May 2. We propose that two mechanisms exist which may lead to AVN of the lunate; either as a localized or global lunate phenomenon. How Does the Disease Affect the Wrist? How important is this topic for board examinations?


In very late disease or failed surgery, the radiolunate articulation dd compromised, in which case a salvage procedure is required. Wilke B, Kakar S. The lunate fracture commences at the point the lunate cantilevers over the edge of the distal radius, and then takes on the shape of the radius.

The Etiology and Pathogenesis of Kienböck Disease

Universidad de Valladolid, Servicio de Publicaciones; The distribution of the fractures corresponds to the shape of the distal radius. With repetitive loading, a stress microfracture will occur, and with further loading, the fracture will propagate.

After one month of medical treatment there was no improvement and a cast was placed for another 2 months. Microanatomy of the lunate.

No visible changes on xray, changes kienbokc on MRI. As emphasized above with SLAC wrist disease, there is progression from dynamic, to static, and then fixed deformity. See J Wrist Surg.

C and D Note the changes on the MRI, including the edema of the volar ligaments at the lunotriquetral articulation white arrow. A Viegas type 1 lunate has a single articular facet for the capitate and positions the capitate in a kirnbock radial direction.

The factors associated with AVN are different depending upon the patients’ age, sex, race, comorbidities, and are also anatomically specific.



La maladie de Kienbock chez le mineur. Image courtesy of Dr. Lee and Gelberman have both studied the arterial supply of the lunate, and reported that a single volar artery can exist, and report that this is likely to be a risk factor for KD.

Coronary disease of the hip. Dynamic changes occur with loss of height of the lunate, which changes the fine balance of the scapholunate ligament, so that the capitate becomes wedged into the scapholunate interval.

Conditions which increase the fat content in bone marrow e. He denies any recent history of trauma to the wrist or hand. Once the subchondral bone is breached, the friable medullary trabeculae are exposed and comminution and collapse occur.

This further increases the intraosseous kienbpck, reduced arterial inflow, and produces necrosis. Core Tested Community All.

L8 – 10 years in practice. Hand Surg ; 7: Therefore, changes in the central column will have a secondary effect on the radial column. Orthopaedics Clinics of N Amer ; 16 4: Deformity and collapse of the central column.