Kienböck's disease in 2021

Area of Science:

• Orthopedics
• Hand Surgery
• Radiology

Background:

• Kienböck's disease, characterized by avascular necrosis of the lunate, has an unclear etiology.
• Progression often leads to wrist degeneration, with conservative treatments yielding poor results in adults.
• Surgical intervention is frequently necessary due to the limitations of non-operative management.

Purpose of the Study:

• To explore the underlying causes and pathophysiology of Kienböck's disease.
• To evaluate the effectiveness of various surgical decompression osteotomy techniques.
• To compare the biomechanical effects of different surgical approaches on the lunate bone.

Main Methods:

• Review of existing literature on Kienböck's disease and surgical treatments.
• Analysis of anatomical factors and their contribution to lunate pathology.
• Comparison of biomechanical outcomes for different osteotomy procedures.

Main Results:

• Kienböck's disease may stem from inflammatory, biological venous thrombosis leading to intraosseous compartment syndrome.
• Certain anatomical factors may predispose to fracture rather than necrosis.
• Decompression osteotomies protect the lunate from collapse but do not heal the necrosis itself.

Conclusions:

• While the exact cause of Kienböck's disease remains elusive, surgical decompression is crucial for preventing lunate collapse.
• Extra-articular techniques preserving vascularization and mid-carpal anatomy are advantageous.
• Further research into biological treatments is warranted, though current palliative options address advanced degeneration.