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Fracture, Lunate/Kienböck Disease, Sports Medicine

Kevin E. Burroughs, MD, CAQSM and Z. Victor Ratajczak, MD Reviewed 04/2019
 


BASICS

DESCRIPTION

  • Kienböck (pronounced “Keen-bock”) disease, or lunatomalacia, is a painful disorder of the wrist, in which there are histologic and radiologic changes showing avascular necrosis of th...

DIAGNOSIS

Lichtman classification of staging for Kienböck disease (via x-ray) 1
  • Stage I: normal architecture and bone density; may be either a linear or a compression fracture

  • Stage II: definite densi...

TREATMENT

  • Acute treatment

    ALERT

    Immobilization:

    • In initial stages, immobilization for 7 days is a reasonable first step because synovitis and tenosynovitis usually resolve, and examination may become mor...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Prompt referral to an orthopedist after detection to evaluate, accurately stage, and discuss with the patient available current treatments 

COMPLICATIONS

  • A continuu...

REFERENCES

1
Allan CH, Joshi A, Lichtman DM. Kienbock’s disease: diagnosis and treatment. J Am Acad Orthop Surg.  2001;9(2):128–136.
2
van Leeuwen WF, Janssen SJ, ter Meulen DP, et al. What is the r...

ADDITIONAL READING

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

  • Bonzar M, Firrell JC, Hainer M, et al. Kienböck di...

CLINICAL PEARLS

  • Most commonly seen in ages 20 to 40 yr with a predilection to the right hand

  • Previous wrist trauma, repetitive trauma, and negative ulnar variance are predisposing factors.

  • X-ray shows s...

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