Learning objectives
Kienböck's disease (KD) represents the osteonecrosis of the lunate.
It is important for the radiologist:
to identify Kienböck's disease
to comprehend the risk of delayed diagnosis
to properly stage the disease
to know the main therapeutic options and post-surgical imaging
Background
Epidemiology
KD mainly affects young adults,
but there are also cases in adolescents and in the elderly.
Men are affected as twice as women.
The disease is rarely bilateral.
Anatomy
The lunate bone is the central bone of the proximal carpal row.
It has two faces without cartilaginous covering,
the palmar and dorsal face through which nutritious vessels penetrate and four articular surfaces:
the proximal articular surface for the distal articular surface of the radius and the triangular fibrocartilage complex,
the medial surface for the...
Imaging findings OR Procedure Details
Imaging findings
Kienböck's disease can be classified at imaging both morphologically and functionally,
in order to evaluate the most appropriate therapeutic choices.
The morphological classification proposed by Lichtman et al.
in 1997 and revised in 2010 [11] uses bone density in radiography and CT attenuation to evaluate the deformation and sclerosis of the lunate.
MRI evaluates changes in the ischemic bone marrow in T1 and T2-weighted images (Table 1).
In the early stages of KD,
due to insufficient blood supply,
the lunate is affected by...
Conclusion
KD should be suspected in case of prolonged wrist pain with or without a history of trauma.
The correct assessment of the disease is done with radiography and CT to assign the disease stage.
Integration with contrast-enhanced MR imaging is crucial in quantifying viable bone portions both in planning appropriate therapeutic options and follow-up,
particularly in advanced stages of disease (stage II-III).
References
Antuña Zapico JM.
Malacia del semilunar.
Valladolid: Universidad de Valladolid; 1966.
Viegas SF,
Wagner K,
Patterson R,
Peterson P.
Medial (hamate) facet of the lunate.
J Hand Surg Am.
Elsevier; 1990;15(4):564–571.
Rhee PC,
Jones DB,
Moran Sl,
Shin AY.
The effect of lunate morphology in Kienböck disease.
L Hand Surg Am.
2015;40:738.
Chung KC,
Spilson MS,
Kim MH.
Is negative ulnar variance a risk factor for Kienbock’s disease? A meta-analysis.
Ann Plast Surg.
United States; 2001;47(5):494–499.
Gelberman RH,
Bauman TD,
Menon J,
Akeson WH.
The...
Personal Information
Giovanni Battista Verrone MD
Department of Emergency Radiology - Careggi University Hospital
L.go Brambilla 3,
50134,
Florence,
Italy.
Email:
[email protected]