Recent Advances in Assessment and Treatment in Kienböck’s Disease

Chojnowski, Karol; Opiełka, Mikołaj; Piotrowicz, Miłosz; Sobocki, Bartosz Kamil; Napora, Justyna; Dąbrowski, Filip; Piotrowski, Maciej; Mazurek, Tomasz

doi:10.3390/jcm11030664

Cited by 10 publications

(14 citation statements)

References 77 publications

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“…However, paediatric and elderly forms has been reported with a better prognosis than the typically 20-40 years patients (2, 13 and 14). Usually, one hand is affected and only 4% of cases are bilateral (15). All our patients had one wrist affected and it were the dominant one in 53%.…”

Section: Discussionmentioning

confidence: 65%

20 Years’ Experience in Treating Kienbock’s Disease: About 15 Cases and Review of Literature

Chalouah

Mohamed

Kamal

et al. 2022

ABCMed

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Kienböck’s disease is a rare condition. It affects young adults who are mostly manual workers. Radiology allows diagnosis and classification of the disease using the Lichtman classification which will guide the therapeutic strategy. The aim of the present work is to review the clinical data, recent advances in assessment methods (MRI and arthroscopy) and our therapeutic results compared to the literature. Material and methods: This is a retrospective study of fifteen cases of Kienböck’s disease, collected in the Traumatology-Orthopaedics Department I of the Mohamed V Military Hospital in Rabat, Morocco, over a 20 years period, from 2001 to 2020. This study included 10 men and 5 women, with an average age of 29 years. All of our patients underwent plain radiographs that allowed diagnosis and staging. Only 6 patients benefited from MR imaging and none of them had cartilage arthroscopic assessment. Radial shortening osteotomy were performed for 14 patients and lunate decompression by forage for one patient with good results in 53% and 14% of poor results. Discussion: Comparing the results of our study with those of the literature, we found concordance regarding clinical, radiological and therapeutic methods. However, this study has shown insufficient use of MRI for viability evaluation of the lunate and cartilage arthroscopic assessment, due in first place to their high cost for developing countries as ours. Thus, treatment choices weren’t accurate enough, which explains our 47% poor to fair results. Conclusion: Kienböck’s disease is a rare condition that should be early diagnosed with accurate staging using recent advances in assessment methods which allows proper treatment choices to prevent its evolution toward total destruction of the wrist. However, patient’s desires and needs, surgeon’s experience and capabilities of their facilities precondition the final decision.

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Section: Discussionmentioning

confidence: 65%

20 Years’ Experience in Treating Kienbock’s Disease: About 15 Cases and Review of Literature

Chalouah

Mohamed

Kamal

et al. 2022

ABCMed

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“…In the first stage, treatment is usually based on immobilization with plaster or splints, conservative treatment is recommended; in the second stage it is also possible to treat conservatively when there is incomplete necrosis, however with complete necrosis, or in the third and fourth stage it will require "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. The main objective in the treatment of stage II is revascularization, unloading and decompression of the lunate (1,14).…”

Section: Figure 3 Degree Of Carpal Collapse By Salmon Et Al Through T...mentioning

confidence: 99%

“…In stage IIIA it usually requires restoration of the lunate, in stage IIIB it is customary to perform a partial arthrodesis of the wrist. As for rescue procedures, such as wrist arthrodesis, they are mainly limited to Lichtman IV (14).…”

Section: Figure 3 Degree Of Carpal Collapse By Salmon Et Al Through T...mentioning

confidence: 99%

Kienböck's Disease, Avascular Necrosis of the Lunate

Pesántez

García

Banegas

et al. 2022

EPRA

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Introduction: Avascular necrosis of the lunate bone was described in 1910 by the Austrian radiologist Robert Kienböck, which is named after him. A mixture of different factors such as mechanical, vascular and genetic predisposition may be related to the pathogenesis of this disease. As for the natural evolution of the disease, failure in early diagnosis and early treatment may lead to a gradual evolution from stage I to stage IV, causing discomfort to the patient. Objective: to detail the current information related to avascular necrosis of the lunate, description, etiology, classification, imaging presentation and management of Kienböck's disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Kienböck, avascular necrosis of the lunate and lunatomalacia. Results: it is the second most frequent cause of avascular necrosis of the carpal bones and generally affects males between 20 and 40 years of age. Nuclear magnetic resonance has a greater contribution due to greater sensitivity and detection of radiographically occult cases, computed tomography also has a good specificity at the time of diagnosis. Radiography at the beginning of the disease does not present evident changes and nuclear scintigraphy presents non-specific findings. In the first stage, the treatment is based on immobilization with a plaster cast or splints. When incomplete necrosis is evidenced in the second stage, conservative treatment can be performed, however with complete necrosis or in the third and fourth stage, it requires "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. Stage IIIA usually merits lunate restoration, in stage IIIB and Lichtman IV wrist arthrodesis can be used. Conclusions: Kienböck's disease presents with unilateral pain over the dorsal aspect of the wrist, weakness and limited wrist motion, in addition to functional impotence, decreased grip strength, wrist edema, sensory disturbances in the median nerve territory and synovitis, depending on the stage. It is related to the following variables such as ulnar minus or ulnar negative variation, vascular contribution of the lunate bone, morphology of the lunate, radial inclination angle. The diagnosis is clinical and imaging where Lichtman's classification is useful. Treatment will depend on the cause and also on the stage of the disease.

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“…Camus and Van Overstraeten expanded the LSB classification and included patient age groups and other treatment options not previously included in the LSB algorithm, such as nonvascularised rib graft and denervation. 1 Despite minor differences, the general principles of treatment are as follows: (1) manage nonoperatively in the young or elderly where possible; (2) protect the lunate if the lunate is intact; (3) reconstruct the lunate if it is salvageable; (4) replace, remove, or bypass the lunate if it is not salvageable; (5) preserve the radiocarpal and/or the midcarpal joint when it is possible; and (6) when pan carpal arthritis occur, consider other salvage procedures such as wrist replacement or total wrist arthrodesis. However, Bhardwaj et al 3 pointed out the key issues with such unifying guidelines, including the lack of consensus in the treatment options, the lack of evidence, and the ongoing debate on the natural progression of KD.…”

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confidence: 99%

“…The decision-making process for the management of adult Kienböck disease (KD) has become complex and may be due to many theories about its pathogenesis, 1 2 various surgical treatments proposed, 2 3 4 5 and many questions that remain unanswered. 6 Various recently published review articles offer different perspectives on the evaluation and management of KD.…”

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confidence: 99%

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Tee,

Butler,

et al. 2024

J Wrist Surg

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Background In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy. Materials and Methods We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD. Results We put forward an investigative algorithm that places into context the investigative roles of MRI, arthroscopy, and CT. Conclusion KD is a rare condition, and there is a lack of comparative studies to help us choose the preferred treatment. The decision on the management options in adult KD may be made by determining the integrity of the lunate cortex and deciding whether the lunate is salvageable or not by CT scan. MRI may provide useful information on the vascular status if the lunate cortex is intact, and the lunate is salvageable. If the lunate is fragmented, it is not salvageable, and MRI does not provide useful information. Arthroscopy has a role in selective cases.

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Recent Advances in Assessment and Treatment in Kienböck’s Disease

Cited by 10 publications

References 77 publications

20 Years’ Experience in Treating Kienbock’s Disease: About 15 Cases and Review of Literature

20 Years’ Experience in Treating Kienbock’s Disease: About 15 Cases and Review of Literature

Kienböck's Disease, Avascular Necrosis of the Lunate

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

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