KIENBOCK'S DISEASE
Kienbock's Disease
Avascular Necrosis (AVN ) of Lunate bone
Stages of Kienbock's disease
I. normal radiographs , possible stress #
II. sclerosis of lunate bone, no collapse
IIIA. fragmentation and early outcome
IIIB. stage IIIA + scapholunate dissociation and fixed rotation
IV. degeneration changes on lunate.
What else to look for in radiography ?
Negative Ulnar variance on AP taken with forearm on midprone position.
What we see on MRI films ?
low signal intensity in T1 film on the lunate bone.
Management options
A. Analgesia
Splintage
B. Operative
Join levelling -Radial shortening
Wrist Denervation
Partial / total wrist fusion
Proximal row carpectomy
Choice depends on diseases stage ,degree of symptoms and patient factors.
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