Kienböck disease (lunate osteonecrosis)

Case contributed by Dr Jose Bacalla

Presentation

Wrist pain. No history of trauma.

Patient Data

Age: 45 years
Gender: Female

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 Litchman classification).

Bone marrow edema most evident in the subcondral region (ulnar side ) of the triquetrum, adyacent sinovitis-like alteration is also seen. Minimun 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 lunate-capitate joint.

No evident changes on the radioscaphoid joint.

 

Case Discussion

Lunate osteonecrosis,  described  and named after Robert  Kienböck in 1910, is a condition in which given to unknown reasons there is an infarction, osteitis and avascular necrosis of this bone, leading to mechanical failure. Some risk factors include negative ulnar variance and repetitive microtrauma.

The Litchman classification allows surgeons to determine what treament may be more effective. If left untreated, it progresses to joint destruction in 3 to 5 years 1. Use of intravenous contrast ( not used in this case) is useful in determining the most appropiate 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-side impaction syndrome, complex regional pain syndrome, intraosseous ganglion cyst or bone island 2

 

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Case information

rID: 79687
Published: 20th Jul 2020
Last edited: 20th Jul 2020
Inclusion in quiz mode: Included
Institution: Hospital Nacional Edgardo Rebagliati Martins

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