Addendum: Kienböck Disease: A New Algorithm for the 21st Century

Modification of the Lichtman Bain Classification

After publication of the above article in the Journal of Wrist Surgery, Volume 6, Number 1, 2017 (DOI: 10.1055/s-0036-1593734), the authors would like to make minor modifications to reflect the importance of the carpal instability of Kienböck's disease, which is then followed by the degenerative changes within the carpus.

In this new classification, the “C” category highlights the effect of Kienböck's disease on the wrist. The secondary effects on the wrist usually begin with instability of the proximal carpal row, with flexion of the scaphoid (RSA > 60⁰, Lichtman IIIB). This is followed by the progressive secondary degenerative changes within the carpus. It will usually commence in the radiolunate articulation, and progresses to the radioscaphoid and finally the midcarpal joint. However, there is some variability of the distribution of the degenerative changes (e.g., a coronal lunate fracture can predispose to earlier degeneration in the midcarpal joint). Further research is required to determine the exact details of the degenerative changes in Kienbock's disease.

With advanced degeneration involving all articulations, the only option is a salvage procedure such as a wrist fusion.

The updated algorithm appears as follows.