Your SlideShare is downloading. ×
0
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Kienbock Disease
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Kienbock Disease

1,088

Published on

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,088
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
69
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. KIENBOCK DISEASE DR. MANOJ BHAMA SENIOR RESIDENT, DEPT. OF ORTHOPAEDICS, S.P. MEDICAL COLLEGE, BIKANER, INDIA mbhama@gmail.com
  • 2. KIENBOCK DISEASE • Synonyms: Avascular Necrosis of Lunate • First Described by Robert Kienbock in 1910; as “traumatic softening” of Lunate bone • It is a painful disorder of wrist, due to avascular necrosis of carpal lunate, due to unknown cause
  • 3. AETIOLOGY • Aetiology = unknown, but several cause have been proposed • vascular compromise from repetitive trauma causes microfracture & excessive stress on microscopic architecture (sports injury) • Ulnar minus variant:- Individual having ulnar minus variance are at increased risk. Short Ulna  increases shear force across the lunate  Causes vascular insufficiency
  • 4. EPIDIMIOLOGY • Age= 15-40 (young individuals) • Sex= Men • Location= Unilateral, Dominant wrist
  • 5. PATHOLOGY Pathological changes proceed in 4 stages:- • Stage 1: Ischemia with naked eye or radiological examination • Stage 2: Trabeculae Necrosis with reactive new bone formation & increased radiographic density, but little or no distortion of shape. • Stage 3: Collapse of Bone • Stage 4: Disruption of Radio-carpal congruence & secondary OA
  • 6. PATHOLOGY • The natural history of Kienbock’s disease is Progressive Sclerosis  Fragmentation  Arthrosis
  • 7. CLINICAL FEATURE • There may be history of trauma with wrist in severe dorsiflexion The lesion presents with 1. Dorsal wrist pain:- Pain may be produced in lunate region by axial strike/injury at distal end of middle finger 2. Swelling 3. Decreased Grip strength 4. Decreased range of motion; particularly in extension. In later stage movement may be painful
  • 8. IMAGING • X-ray at first show no abnormality but bone scan may reveals increased activity • Later x-ray may show either mottled or diffuse density of bone – to – osteoarthritic changes in wrist • MRI Most reliable way of detecting the early change
  • 9. CLASSIFICATION • Kienbock disease advances through 4 radiological stages • Stage I : Normal architecture; consistent with Microfracture (Lunate abnormal on bone scan) • Stage II : Lunate sclerosis without collapse • Stage III : Lunate collapse or Fragmentation & proximal migration of capitate • Stage IV : Perilunate arthritis changes
  • 10. TREATMENT A Conservative Casting of wrist for several wks ; for early stages of disease ( St I or II, before sclerosis, fragmentation or collapse) But- Unacceptable & Ineffective B Operative • Surgery is only definitive treatment
  • 11. Early Disease Stage I & II • Unloading the Lunate* • 1. Ulnar lengthening • Transverse osteotomy at distal ulna  Distraction  Cortical iliac graft  Tightening of plate screw
  • 12. Early Disease Stage I & II 2. Radial Shortening Indication – Negative ulnar variance – Lunate compression fracture without fragmentation or flattening Procedure Transverse osteotomy shortening of radius 3” proximal to distal by 2 cm articulating surface fixing the bone with compression plate
  • 13. In stage III 1. Ulnar lengthening 2. Silicon prosthesis - silicon synovitis - foreign body cyst 3. Interacarpal fusion 4. Lunate excision 5. Arthrodesis Tri scaphe Scaphocapitate
  • 14. In stage IV • Proximal carpal row resection • Wrist arthrodesis

×