Kienbock's Disease

Question 1

What is the classification for Kienbock’s?

Answer 1

Lichtman
I- no lunate changes on XR, changes on MRI
II- lunate sclerosis
IIIA- lunate collapse w/o scaphoid rotation
IIIB- lunate collapse with fixed scaphoid rotation
VI- degeneration of adjacent carpal joints

Question 2

What is the treatment for Kienbock’s?

Answer 2

Depends on stage and ulnar variance
I, II, IIIA- treated with radial or ulnar osteotomy and /or distal radius/lunate core decompression
II, IIIA, IIIB- treated with STT fusion
IIIB, IV- PRC or wrist fusion

Question 3

How is Kienbock’s in the pediatric patients treated?

Answer 3

Temporary STT pinning

Question 4

What is the supposed cause of Kienbock’s?

Answer 4

AVN of lunate due repetitive trauma from ulnar negative variance