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The Etiology of Kienböck’s Disease

  • Gregory Ian BainEmail author
  • Carlos IrisarriEmail author
Chapter

Abstract

This chapter reviews the conceptual aspects of the etiology of Kienböck’s disease. The stress fracture model would account for many of the cases we see in clinical practice with the “at risk” lunate. The fracture commences on the proximal radial aspect of the lunate and corresponds to the shape of the distal radius. There can be a coronal fracture of the lunate due to the nutcracker effect. Abrasion and reabsorption of the medullary bone can lead to comminution and collapse of the lunate.

Avascular necrosis is often considered to be a compartment syndrome of bone. Although it is common to be concerned about the arterial supply of the lunate in Kienböck’s disease, it is more likely to be a venous condition. Jensen has demonstrated increased intraosseous pressure within the Kienböck’s lunate compared to the normal lunate. Crock demonstrated that the subarticular venous plexus consists of wavy parallel venules that are precariously placed directly adjacent to the thin subchondral bone plate.

We postulate that the venous condition could be a local condition secondary to the stress fracture. Alternatively it occurs as a extraosseous venous obstruction that produces a global venous ischemia.

Finally there is a small group of patients who have a global ischemia, with sclerosis of the entire lunate, and often have a reactive enhancement of the lunate with gadolinium. These patients have a better prognosis.

Keywords

Kienböck’s disease Kienböck’s etiology Lunatomalacia Lunate necrosis Carpal avascular necrosis Lunate osteochondrosis Kienböck’s risk factors Pathology 

Supplementary material

Video 7.1

Mechanism of stress fracture of lunate in type 1 lunate wrist. With ulnar deviation the wrist radioscaphocapitate and radiolunate ligaments becomes taut, and the capitate becomes a nutcracker on the lunate. A stress fracture commences on the ulnar ridge of the distal radius, while the “uncovered” part of the lunate is not loaded (MP4 3968 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Upper Limb and Research, Department of Orthopedic SurgeryFlinders University and Flinders Medical CentrerAdelaideAustralia
  2. 2.Hand Surgery UnitHospital Vithas-FátimaVigoSpain

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