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The Etiology of Kienböck’s Disease

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Kienböck’s Disease

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Abstract

This chapter reviews the conceptual aspects of the etiology of Kienböck’s disease. The stress fracture model would account for many of the cases we see in clinical practice with the “at risk” lunate. The fracture commences on the proximal radial aspect of the lunate and corresponds to the shape of the distal radius. There can be a coronal fracture of the lunate due to the nutcracker effect. Abrasion and reabsorption of the medullary bone can lead to comminution and collapse of the lunate.

Avascular necrosis is often considered to be a compartment syndrome of bone. Although it is common to be concerned about the arterial supply of the lunate in Kienböck’s disease, it is more likely to be a venous condition. Jensen has demonstrated increased intraosseous pressure within the Kienböck’s lunate compared to the normal lunate. Crock demonstrated that the subarticular venous plexus consists of wavy parallel venules that are precariously placed directly adjacent to the thin subchondral bone plate.

We postulate that the venous condition could be a local condition secondary to the stress fracture. Alternatively it occurs as a extraosseous venous obstruction that produces a global venous ischemia.

Finally there is a small group of patients who have a global ischemia, with sclerosis of the entire lunate, and often have a reactive enhancement of the lunate with gadolinium. These patients have a better prognosis.

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Authors and Affiliations

  1. Upper Limb and Research, Department of Orthopedic Surgery, Flinders University and Flinders Medical Centrer, Bedford Park, Adelaide, SA, Australia

    Gregory Ian Bain MBBS, FRACS, FA(Ortho)A, PhD (Professor)

  2. Hand Surgery Unit, Hospital Vithas-Fátima, Vía Norte, 48, Vigo, Pontevedra, 36206, Spain

    Carlos Irisarri MD

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  1. Gregory Ian Bain MBBS, FRACS, FA(Ortho)A, PhD
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  2. Carlos Irisarri MD
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Correspondence to Gregory Ian Bain MBBS, FRACS, FA(Ortho)A, PhD or Carlos Irisarri MD .

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Editors and Affiliations

  1. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    David M. Lichtman

  2. Department of Orthopedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia

    Gregory Ian Bain

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Mechanism of stress fracture of lunate in type 1 lunate wrist. With ulnar deviation the wrist radioscaphocapitate and radiolunate ligaments becomes taut, and the capitate becomes a nutcracker on the lunate. A stress fracture commences on the ulnar ridge of the distal radius, while the “uncovered” part of the lunate is not loaded (MP4 3968 kb)

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Bain, G.I., Irisarri, C. (2016). The Etiology of Kienböck’s Disease. In: Lichtman, D., Bain, G. (eds) Kienböck’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-34226-9_7

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  • DOI: https://doi.org/10.1007/978-3-319-34226-9_7

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