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J Wrist Surg 2024; 13(04): 294-301
DOI: 10.1055/s-0043-1778064
Special Review: Decision-making in Kienböck Disease

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease

Richard Tee
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
,
Stephen Butler
2   Department of Plastic and Hand Surgery, St Vincents Hospital, Fitzroy, Victoria, Australia
,
Eugene T. Ek
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
3   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, Victoria, Australia
,
Stephen K. Tham 
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
2   Department of Plastic and Hand Surgery, St Vincents Hospital, Fitzroy, Victoria, Australia
3   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, Victoria, Australia
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Abstract

Background In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy.

Materials and Methods We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD.

Results We put forward an investigative algorithm that places into context the investigative roles of MRI, arthroscopy, and CT.

Conclusion KD is a rare condition, and there is a lack of comparative studies to help us choose the preferred treatment. The decision on the management options in adult KD may be made by determining the integrity of the lunate cortex and deciding whether the lunate is salvageable or not by CT scan. MRI may provide useful information on the vascular status if the lunate cortex is intact, and the lunate is salvageable. If the lunate is fragmented, it is not salvageable, and MRI does not provide useful information. Arthroscopy has a role in selective cases.

Keywords

Kienböck disease - imaging - classification

Ethical Review

No ethical review required for this special review section.




Publication History

Received: 11 September 2023

Accepted: 05 December 2023

Article published online:
15 January 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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