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The Future of Kienböck’s Disease: A New Algorithm

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Kienböck’s Disease

Abstract

This book contains extensive descriptions of many of the finer points of Kienböck’s disease, which have evolved over the past 100+ years. The last two decades in particular have seen the introduction of advanced information regarding the etiology, natural history, classification, and treatment options for lunate osteonecrosis. New classification systems have been developed based on advanced imaging, perfusion studies of lunate viability and arthroscopic assessment of the articular cartilage. This chapter brings together the many facets of this book and presents a new treatment algorithm, incorporating the traditional osseous classification system (Lichtman) with the perfusion/viability classification (Schmitt) and the articular cartilage classification (Bain). From this broad base, we have developed a new algorithm to manage Kienböck’s avascular necrosis of the lunate.

The new algorithm incorporates the understanding of the diseased lunate and how it affects the wrist. In the earliest stages and in patients with a good prognosis, the “intact lunate” is initially protected utilizing nonoperative measures. With failure to respond, the next step is an appropriate lunate unloading procedure. The “compromised lunate” can be reconstructed with a medial femoral condyle graft or PRC. With further lunate collapse, the wrist will become compromised, and also collapse and develop localized degeneration. This “compromised wrist” still has functional articulations, which enable motion-preserving procedures to be performed to maintain a functional wrist. With more advanced disease (Kienböck’s Disease Advanced Collapse, or KDAC), the wrist is no longer reconstructable, so a salvage procedure is required.

In addition to these objective pathoanatomical factors, the final decision must take into account various patient factors that include age, general health, lifestyle, financial constraints, and future demands to be placed on the wrist. Finally, the surgeon’s skill set, equipment, and work environment must be considered.

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References

  1. Kienböck R. Über traumatische Malazie des Mondbeins und ihre Folgezustände: Entartungsformen und Kompressionsfrakturen, Fortschritte a.d. Gebiete d. Röntgenstrahlen, 1910; XVI(2):77–103

    Google Scholar 

  2. Lutsky K, Beredjiklian PK. Kienbock disease. J Hand Surg Am. 2012;37(9):1942–52.

    Article  PubMed  Google Scholar 

  3. Keith PP, Nuttall D, Trail I. Long-term outcome of nonsurgically managed Kienböck’s disease. J Hand Surg Am. 2004;29(1):63–7.

    Article  PubMed  Google Scholar 

  4. Salmon J, Stanley JK, Trail IA. Kienböck’s disease: conservative management versus radial shortening. J Bone Joint Surg Br. 2000;82(6):820–3.

    Article  CAS  PubMed  Google Scholar 

  5. Beckenbaugh RD, Shives TC, Dobyns JH, Linscheid RL. Kienböck’s disease: the natural history of Kienböck’s disease and consideration of lunate fractures. Clin Orthop Relat Res. 1980;149:98–106.

    PubMed  Google Scholar 

  6. Lichtman DM, Mack GR, MacDonald RI, Gunther SF, Wilson JN. Kienböck’s disease: the role of silicone replacement arthroplasty. J Bone Joint Surg Am. 1977;59(7):899–908.

    CAS  PubMed  Google Scholar 

  7. Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienböck’s disease. Hand Clin. 1993;9(3):409–16.

    CAS  PubMed  Google Scholar 

  8. Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienböck’s disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 2010;35(7):549–54.

    Article  CAS  PubMed  Google Scholar 

  9. Arco News. Association research circulation osseous (ARCO): committee on terminology and classification. ARCO News. 1992;4:41–6.

    Google Scholar 

  10. Schmitt R, Kalb KH. Imaging in Kienböck’s disease. Handchir Mikrochir Plast Chir. 2010;42:162–70.

    Article  CAS  PubMed  Google Scholar 

  11. Schmitt R, Heinze A, Fellner F, Obletter N, Strühn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997;25(2):92–103.

    Article  CAS  PubMed  Google Scholar 

  12. Bain GI, Begg M. Arthroscopic assessment and classification of Kienböck’s disease. Tech Hand Up Extrem Surg. 2006;10(1):8–13.

    Article  PubMed  Google Scholar 

  13. Bain GI, Durrant A. An articular-based approach to Kienbock avascular necrosis of the lunate. Tech Hand Up Extrem Surg. 2011;15(1):41–7.

    Article  PubMed  Google Scholar 

  14. Bain GI, McGuire DT. Decision making for partial carpal fusions. J Wrist Surg. 2012;1(2):103–14.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fontaine C. Kienböck’s disease. Chir Main. 2015;34(1):4–17.

    Article  CAS  PubMed  Google Scholar 

  16. Irisarri C, Kalb K, Ribak S. Infantile and juvenile lunatomalacia. J Hand Surg Eur Vol. 2010;35(7):544–8.

    Article  CAS  PubMed  Google Scholar 

  17. Jorge-Mora A, Pretell-Mazzini J, Marti-Ciruelos R, Andres-Esteban EM, Curto de la Mano A. Distal radius definitive epiphysiodesis for management of Kienböck’s disease in skeletally immature patients. Int Orthop. 2012;36(10):2101–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Geutjens GG. Kienböck’s disease in an elderly patient. J Hand Surg Am. 1995;20(1):42–3.

    Article  CAS  PubMed  Google Scholar 

  19. Taniguchi Y, Yoshida M, Iwasaki H, Otakara H, Iwata S. Kienböck’s disease in elderly patients. J Hand Surg Am. 2003;28(5):779–83.

    Article  PubMed  Google Scholar 

  20. Yoshida T, Tada K, Yamamoto K, Shibata T, Shimada K, Kawai H. Aged-onset Kienböck’s disease. Arch Orthop Trauma Surg. 1990;109(5):241–6.

    Article  CAS  PubMed  Google Scholar 

  21. Giunta R, Lower N, Wilhelm K, Keirse R, Rock C, Muller-Gerbl M. Altered patterns of subchondral bone mineralization in Kienböck’s disease. J Hand Surg Br. 1997;22(1):16–20.

    Article  CAS  PubMed  Google Scholar 

  22. Thomas AA, Rodriguez E, Segalman K. Kienböck’s disease in an elderly patient treated with proximal row carpectomy. J Hand Surg Am. 2004;29(4):685–8.

    Article  PubMed  Google Scholar 

  23. Higgins JP, Bürger HK. Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications. J Reconstr Microsurg. 2014;30(7):483–90.

    Article  PubMed  Google Scholar 

  24. Burger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am. 2013;38(4):690–700.

    Article  PubMed  Google Scholar 

  25. Saffar P. Vascularized pisiform transfer in place of lunatum for Kienböck’s disease. Chir Main. 2010;29 Suppl 1:S112–8.

    Article  PubMed  Google Scholar 

  26. Roca J, Beltran JE, Fairen MF, Alvarez A. Treatment of Kienböck’s disease using a silicone rubber implant. J Bone Joint Surg Am. 1976;58:373–6.

    CAS  PubMed  Google Scholar 

  27. Werthel JD, Hoang DV, Boyer P, Dallaudière B, Massin P, Loriaut P. Treatment of Kienböck’s disease using a pyrocarbon implant: case report. Chir Main. 2014;33(6):404–9.

    Article  CAS  PubMed  Google Scholar 

  28. Bellemère P, Maes-clavier C, Loubersac T, Gaisne E, Kerjean Y, Collon S. Pyrocarbon interposition wrist arthroplasty in the treatment of failed wrist procedures. J Wrist Surg. 2012;1(1):31–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yajima H, Ono H, Tamai S. Temporary internal fixation of the scaphotrapezio-trapezoidal joint for the treatment of Kienböck’s disease: a preliminary study. J Hand Surg Am. 1998;23(3):402–10.

    Article  CAS  PubMed  Google Scholar 

  30. Yasuda M, Okuda H, Egi T, Guidera PM. Temporary scapho-trapezoidal joint fixation for Kienböck’s disease in a 12-year-old girl: a case report. J Hand Surg Am. 1998;23(3):411–4.

    Article  CAS  PubMed  Google Scholar 

  31. Shigematsu K, Yajima H, Kobata Y, Kawamura K, Nakanishi Y, Takakura Y. Treatment of Kienbock disease in an 11-year-old girl with temporary fixation of the scaphotrapeziotrapezoidal joint. Scand J Plast Reconstr Surg Hand Surg. 2005;39(1):60–3.

    Article  PubMed  Google Scholar 

  32. Kazuki K, Uemura T, Okada M, Egi T. Time course of magnetic resonance images in an adolescent patient with Kienböck’s disease treated by temporary scaphotrapezoidal joint fixation: a case report. J Hand Surg Am. 2006;31(1):63–7.

    Article  PubMed  Google Scholar 

  33. Ando Y, Yasuda M, Kazuki K, Hidaka N, Yoshinaka Y. Temporary scaphotrapezoidal joint fixation for adolescent Kienböck’s disease. J Hand Surg Am. 2009;34(1):14–9.

    Article  PubMed  Google Scholar 

  34. Illarramendi AA, Schulz C, De Carli P. The surgical treatment of Kienböck’s disease by radius and ulna metaphyseal core decompression. J Hand Surg Am. 2001;26(2):252–60.

    Article  CAS  PubMed  Google Scholar 

  35. Bain GI, Smith ML, Watts AC. Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate. Tech Hand Up Extrem Surg. 2011;15(1):66–9.

    Article  PubMed  Google Scholar 

  36. Mehrpour SR, Kamrani RS, Aghamirsalim MR, Sorbi R, Kaya A. Treatment of Kienbock disease by lunate core decompression. J Hand Surg Am. 2011;36(10):1675–7.

    Article  PubMed  Google Scholar 

  37. Leblebicioğlu G, Doral MN, Atay öA, Tetik O, Whipple TL. Open treatment of stage III Kienböck’s disease with lunate revascularization compared with arthroscopic treatment without revascularization. Arthroscopy. 2003;19(2):117–30.

    Article  PubMed  Google Scholar 

  38. Menth-Chiari WA, Poehling GG, Wiesler ER, Ruch DS. Arthroscopic debridement for the treatment of Kienböck’s disease. Arthroscopy. 1999;15(1):12–9.

    Article  CAS  PubMed  Google Scholar 

  39. Pegoli L, Ghezzi A, Cavalli E, Luchetti R, Pajardi G. Arthroscopic assisted bone grafting for early stages of Kienböck’s disease. Hand Surg. 2011;16(2):127–31.

    Article  CAS  PubMed  Google Scholar 

  40. Gelberman RH, Bauman TD, Menon J, Akeson WH. The vascularity of the lunate bone and Kienböck’s disease. J Hand Surg Am. 1980;5(3):272–8.

    Article  CAS  PubMed  Google Scholar 

  41. Wilhelm A. Partial joint denervation: wrist, shoulder and elbow. Plast Reconstr Surg. 2010;126(1):345–7.

    Article  CAS  PubMed  Google Scholar 

  42. Quenzer DE, Dobyns JH, Linscheid RL, Trail IA, Vidal MA. Radial recession osteotomy for Kienböck’s disease. J Hand Surg Am. 1997;22(3):386–95.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    David M. Lichtman MD (Rear Admiral (Retired), US Navy Adjunct Professor)

  2. Department of Orthopedic Surgery, University of North Texas Health Sciences Center, Fort Worth, TX, USA

    David M. Lichtman MD (Rear Admiral (Retired), US Navy Adjunct Professor)

  3. Department of Orthopedic Surgery, John Peter Smith Hospital, 1500 S. Main St, Fort Worth, TX, 76104, USA

    William F. Pientka II MD

  4. 6155 Highwoods Ct., Fort Worth, TX, 76112, USA

    William F. Pientka II MD

  5. Upper Limb and Research, Department of Orthopedic Surgery, Flinders University and Flinders Medical Centrer, Bedford Park, Adelaide, SA, Australia

    Gregory Ian Bain MBBS, FRACS, FA(Ortho)A, PhD (Professor)

Authors
  1. David M. Lichtman MD
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  2. William F. Pientka II MD
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  3. Gregory Ian Bain MBBS, FRACS, FA(Ortho)A, PhD
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Corresponding author

Correspondence to David M. Lichtman MD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    David M. Lichtman

  2. Department of Orthopedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia

    Gregory Ian Bain

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Lichtman, D.M., Pientka, W.F., Bain, G.I. (2016). The Future of Kienböck’s Disease: A New Algorithm. In: Lichtman, D., Bain, G. (eds) Kienböck’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-34226-9_30

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  • DOI: https://doi.org/10.1007/978-3-319-34226-9_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34224-5

  • Online ISBN: 978-3-319-34226-9

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