Presentation
Wrist pain. No history of trauma.
Patient Data
There is coronal chronic fracture of the lunate bone with elongation in the anteroposterior diameter, in keeping with type III-C Kienböck disease (according to Lichtman classification).
Bone marrow edema most evident in the subchondral region (ulnar side) of the triquetrum, adjacent synovitis-like alteration is also seen. Minimum changes in the dorsal aspect of the capitate.
Soft tissue edema on the ulnar side of the wrist.
Small ganglion cyst arising in the dorsal aspect of the lunocapitate joint.
No evident changes of the radioscaphoid joint.
Case Discussion
Lunate osteonecrosis, described and named after Robert Kienböck in 1910, is a condition in which given unknown reasons there is infarction, osteitis, and avascular necrosis of this bone, leading to mechanical failure. Some risk factors include negative ulnar variance and repetitive microtrauma.
The Lichtman classification allows surgeons to determine what treatment may be more effective. If left untreated, it progresses to joint destruction in 3 to 5 years 1. The use of intravenous contrast (not used in this case) is useful in determining the most appropriate treatment for stages II and III-B.
Although CT and x-ray may allow diagnosis in stages II, III, or IV; MRI is useful not only in confirming this diagnosis but also for ruling out pseudo-Kienböck lesions that include acute bone contusion, infantile and juvenile lunatomalacia, arthritis, ulnar impaction syndrome, complex regional pain syndrome, intraosseous ganglion cyst or bone island 2.
Unable to process the form. Check for errors and try again.