Kienböck disease (lunate osteonecrosis)
Wrist pain. No history of trauma.
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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.
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
- Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienböck disease: the state of the art and a look at the future. J Hand Surg Eur Vol 2010; 35:549–554
- Javier Arnaiz, Tatiana Piedra, Luis Cerezal, John Ward, Alex Thompson, Jorge A. Vidal, Ana Canga. Imaging of Kienböck Disease. (2014) American Journal of Roentgenology. 203 (1): 131-9. doi:10.2214/AJR.13.11606 - Pubmed