Information for Patients

From the American Academy of Orthopaedic Surgeons

Kienböck's Disease

by David J. Bozentka, MD; Pedro K. Beredjiklan, MD

Kienböck's disease, or osteonecrosis of the lunate bone, can lead to intermittent pain, weakness, and limited range of motion in the wrist. Patients often experience pain for a long period of time (months to years) before seeking medical treatment. The etiology of Kienböck's disease is multifactorial. Certain factors put the lunate bone at risk of osteonecrosis, including its blood supply and geometry, trauma, and various underlying disorders, such as sickle cell anemia, athetosis, and ulnar negative variance. Nonsurgical treatment that includes splinting or cast immobilization can be considered for patients with stage I Kienböck's disease. Surgical options descrbed in this article include procedures for lunate unloading (radial shortening osteotomy, capitate-shortening osteotomy), revascularization (vascularized bone grafting), preserving motion (scaphocapitate fusion), and salvage (proximal row carpectomy, total wrist arthrodesis).

Keywords: lunate, lunatomalacia, avascular necrosis, osteonecrosis, incidence, mechanism of injury, etiology, classification, diagnosis, patient history, physical examination, imaging, radiography, bone scan, MRI, CT, differential diagnosis, management, nonsurgical treatment, surgical treatment, indications, contraindications, radial-shortening osteotomy, vascularized bone graft, capitate-shortening osteotomy, scaphocapitatate fusion, intercarpal arthrodesis, proximal row carpectomy, total wrist arthrodesis,total wrist fusion,complications,rehabilitation

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