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Stahl classification of Kienbock disease

Dr Jeremy Jones and Dr Andrew Dixon et al.

Plain film staging can be useful in the treatment of Kienbock disease (avascular necrosis of the lunate). Stahl's classification, modified by Lichtman, is most commonly used ¹. This system divides the disease into 5 stages :

stage I : normal radiograph
stage II : increased radiodensity of lunate with possible decrease of lunate height on radial side only
stage IIIa : lunate collapse, no scaphoid rotation
stage IIIb : lunate collapse, fixed scaphoid rotation
stage IV : degenerative changes around lunate