Recent Advances in Assessment and Treatment in Kienbock's Disease

Kienbock's disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienbock's disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienbock disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienbock cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

Automated summary

Kienbock's disease is a rare condition characterized by avascular necrosis of the lunate bone, leading to reduced wrist motion, pain, and swelling. Despite advancements in treatment, the cause and pathophysiology of the disease remain unclear. Risk factors include anatomical features, blood supply differences, increased intraosseous pressure, trauma, and environmental factors. Treatment selection is challenging due to the lack of direct correlation between radiographic features and clinical symptoms, as well as variations among age groups. Treatment options range from nonoperative management to bone grafting procedures.