Sakit ni Kienböck Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang mahinang sakit o matulis na sakit sa gilid ng hinlalaki ng iyong pulso. Dito matatagpuan ang lunate bone sa gitna ng iyong wrist joint. Karaniwang dahan-dahan ang simula ng sakit. Sa simula, maaaring magmukhang simpleng strain ito. Sa paglipas ng panahon, ang kondisyon ay karaniwang itinuturing na progressive. Ibig sabihin, maaaring lumala ang mga sintomas kung hindi ito gagamutin.

Maaaring maramdaman mong matigas ang iyong pulso, lalo na sa umaga. Maaari mong mapansin ang pamamaga sa paligid ng masakit na lugar. Maaaring mahirap na ang mga simpleng galaw. Nakakasakit ang pag-abot sa likod upang isara ang bra. Maaaring hindi komportable ang pagtutukoy ng shirt. Maaaring mag-trigger ng flare-up ang pag-angat ng mga bagay, kahit magaan. Karaniwang lumalala ang sakit pagkatapos ng aktibidad. Maaaring mas ramdam mo ito sa dulo ng araw.

May mga tao na nakikita na mas malala ang sakit sa gabi. Maaaring partikular na hindi komportable ang pagtulog sa apektadong gilid. Maaaring gumising ka na may matigas at masakit na pulso. Ang pagpahinga ng kamay sa neutral na posisyon ay madalas tumutulong upang bawasan ang pressure. Gayunpaman, hindi ganap na kilala ang natural na kasaysayan ng kondisyong ito. Ibig sabihin, hindi namin maipapredict kung paano eksaktong magbabago ang iyong mga sintomas sa paglipas ng panahon.

Ang lakas ng iyong sakit sa simula ay maaaring umasa sa hugis ng iyong lunate bone. May ilang istruktura ng buto na mas madaling maapektuhan ng maagang pagbabago. Dahil madalas na nalalampasan ng mga tradisyonal na X-ray ang mga maagang senyales ng collapse, ang iyong mga sintomas ang pangunahing gabay. Maaaring maramdaman mo ang pakiramdam ng clicking o grinding kapag gumagalaw ka ng iyong pulso. Ito ay dulot ng paglipat ng mga buto mula sa kanilang normal na alignment.

Karaniwan na ramdamin ang frustrasyon dahil sa unpredictability ng sakit. Maaaring magtanong ka kung bakit mas maganda ang ilang araw kaysa sa iba. Ang pag-unlad ng Kienböck disease ay malamang na multifactorial. Ibig sabihin, maraming salik ang nag-aambag dito, hindi lamang iisang sanhi. Ang pag-unawa sa iyong mga sintomas ay tumutulong sa amin na pumili ng tamang gamutan para sa iyo. Maging kailangan mo ng pahinga, splinting, o surgery, ang layunin ay bawasan ang sakit na ito at ibalik ang function.

Ano ang nangyayari

Ang iyong pulso ay binubuo ng walong maliit na buto na tinatawag na carpals. Naka-stack sila sa dalawang hilera upang bigyan ang iyong kamay ng lakas at flexibility. Sa Kienböck’s disease, isa sa mga butong ito, ang lunate, ay nawawalan ng supply ng dugo. Walang dugo, ang tissue ng buto ay nagsisimulang mamatay. Ang prosesong ito ay tinatawag na avascular necrosis.

Habang namamatay ang buto, nawawalan ito ng lakas. Hindi na nito kayang hawakan ang araw-araw na load ng iyong mga galaw. Sa paglipas ng panahon, ang lunate ay nagsisisingit at nagkakabagsak. Ang pagbagsak na ito ay nagbabago sa paraan kung paano gumagalaw ang ibang mga buto sa iyong pulso sa isa’t isa. Ang makinis na galaw ng pag-slide ay naging magaspang at hindi regular.

Ang pagbabagong estruktural na ito ang nagdudulot ng iyong pangunahing mga sintomas. Ang mga maling alignment na mga buto ay nagkukuskos, na lumilikha ng sakit at stiffness. Maaari kang maramdaman ang pakiramdam ng pagkagiling kapag gumagalaw ang iyong pulso. Ang instability ay maaari ring magpahina sa iyong hawak. Ipinapaliwanag ng iyong surgeon na hindi ito simpleng pagkasira sa ibabaw. Ito ay isang malalim na pagkabigo ng estruktura sa loob ng core ng joint.

Pinapagaling namin ito sa pamamagitan ng pagbabalik ng balanse sa carpal row. Sa mga advanced na kaso, maaari naming alisin ang nasirang lunate. Pagkatapos namin ito ay istabilisa ang natitirang mga buto gamit ang tendon grafts o mga teknik ng fusion. Ang mga prosedurang ito ay nagbabalik ng integridad ng proximal carpal row. Tumutulong ito sa iyong pulso na gumalaw nang makinis muli.

Para sa mas batang mga pasyente, madalas naming ginagamit ang mga bone grafts upang suportahan ang namamatay na buto. Maaari nitong pigilan ang pagbagsak at mapanatili ang motion. Sa ilang kaso, pinapapalitan namin ang radius bone upang bawasan ang pressure sa lunate. Ang simpleng pag-aadjust na ito ay maaaring magbigay ng mas magandang resulta sa loob ng hanggang isang dekada sa 75% ng mga pasyente.

Ang aming layunin ay laging protektahan ang iyong natitirang malusog na mga ibabaw ng joint. Sa pamamagitan ng pagwawasto ng alignment, binabawasan namin ang abnormal na stress sa cartilage. Tumutulong ito sa pag-iwas sa karagdagang arthritis. Inaangkop namin ang bawat plano sa iyong edad at antas ng aktibidad. Kailangan mo man ng pansamantalang pag-aayos o permanenteng rekonstruksyon, layunin naming ibalik ang function at bawasan ang sakit.

Ano ang maaari naming gawin dito

Si Dr. Kieran Hirpara, isang surgeon sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, ay gumagamit ng pamamaraan sa aming klinika na ang paggamot ay inaayon sa yugto ng iyong kondisyon. Dumating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang pagsusuri sa klinika ang nagtatatag ng diagnosis. Para sa mga degenerative o matagal nang problema, karaniwan naming sinisimulan ang non-operative na paggamot. Para sa mga structural o acute na problema, maaaring direktang irekomenda ang operasyon.

Maaari kang magsimula sa self-management at physiotherapy. Ang pagbabago sa aktibidad ay tumutulong upang bawasan ang stress sa pulso. Layunin ng physiotherapy na mapanatili ang galaw at palakasin ang mga katabing kalamnan. Ang paggamit ng splint ay maaaring sumuporta sa pulso habang ginagawa ang mga pang-araw-araw na gawain. Karaniwan naming inirerekomenda na bigyan ng patas na pagsubok ang pamamaraang ito upang makita kung nababawasan ang iyong sakit at napapabuti ang function bago isaalang-alang ang mga karagdagang hakbang.

Ang medical management ay nakatuon sa pagkontrol ng mga sintomas. Ang mga gamot pang-alis ng sakit at anti-inflammatories ay maaaring tumulong sa pamamahala ng hindi komportableng pakiramdam. Ang mga injection, tulad ng cortisone, ay maaaring bawasan ang pamamaga at sakit para sa isang limitadong panahon. Ang mga injection ng hyaluronic acid o platelet-rich plasma (PRP) ay minsan itinuturing upang suportahan ang kalusugan ng kasu-kasuan, bagama't nag-iiba-iba ang tagal ng benepisyo. Layunin ng mga opsyong ito na panatilihing komportable ka habang pinagsasamantalahan namin kung paano umuunlad ang sakit.

Ang operasyon ay itinuturing kapag ang conservative na paggamot ay hindi nagbigay ng sapat na pagpapabuti o kung ang sakit ay advanced na. Ang aming layunin ay alisin ang sakit at mapanatili ang function ng pulso. Ang mga opsyon ay nagsisimula sa mga prosedura na nagpapababa ng stress sa buto hanggang sa mga nagf-fuse ng mga kasu-kasuan para sa katatagan. Ipinapaliwanag namin sa iyo ang tiyak na surgical na opsyon batay sa iyong yugto at mga layunin, na tinitiyak na nauunawaan mo kung ano ang kinabibilangan ng operasyon at kung ano ang inaasahan mo sa panahon ng paggaling.

Ano ang inaasahan

Ang Kienböck’s disease ay isang kondisyon kung saan nababawasan ang suplay ng dugo sa isang maliit na buto ng pulso, na nagdudulot ng pagpapahina at pagkabagsak nito. Ang prosesong ito ay karaniwang progressive, ibig sabihin ay kumakalma ito sa paglipas ng panahon kung hindi ito gagamutin. Sa mga advanced na yugto, ang sakit ay maaaring magdulot ng malawakang wear-and-tear arthritis sa pulso. Dahil hindi ganap na maipredikto ang natural na pag-unlad ng kondisyong ito, ang iyong surgeon ay magmamasid nang mahigpit sa iyong pag-unlad upang matukoy ang pinakamainam na oras para sa intervention.

Kung walang gamutan, ang mga sintomas ay madalas na nananatili at maaaring unti-unting lumala. Gayunpaman, ang angkop na pamamahala ay nagbibigay-daan sa malaking pagpapagaan. Para sa mga mas batang pasyente, ang mga prosedura tulad ng bone realignment ay maaaring mapabuti ang mga sintomas at itsura ng pulso sa X-ray sa maikling panahon. Para sa mga mas matandang matatanda na may mas advanced na collapse, ang mga pagpipilian tulad ng pagkakaisa ng mga partikular na buto o pag-alis ng nasirang buto ay dinisenyo upang magbigay ng long-term na benepisyo. Layunin ng mga pamamaraang ito na itigil ang pag-unlad ng sakit at mapanatili ang function.

Kapag maayos na pinamamahalaan, maraming pasyente ang nakakaranas ng malaking pagpapabuti. Halimbawa, ang radial shortening osteotomy—isang prosedura na nag-aayos ng haba ng buto ng forearms—ay nagbibigay ng pagpapabuti na tumatagal ng dekada sa 75% ng mga pasyente na may symptomatic na sakit. Iba pang mga prosedura, tulad ng scaphocapitate arthrodesis kasama ang lunate excision, ay ipinakita na malaki ang pagpapagaan ng sakit at pagpapanatili ng sapat na lakas ng hawak sa loob ng average na 10.7 taon. Kahit sa mga advanced na kaso, ang mga carpal-sparing surgeries ay maaaring maging epektibo, at ang proximal row carpectomy ay nananatiling matibay na pagpipilian para sa pagpapanatili ng range of motion at lakas ng pulso sa loob ng sampung taon.

Mahalagang tandaan na ang radiographic na pag-unlad ng sakit sa loob ng isang taon o higit pa ay bahagya lamang sa average, anuman ang piniling gamutan. Ibig sabihin, habang mabagal ang mga underlying na structural na pagbabago, ang mga clinical na sintomas—tulad ng sakit at stiffness—ang pangunahing layunin namin na pagbutihin. Ang iyong surgeon ay magtatakda ng plano ayon sa iyong partikular na yugto ng sakit, tinitiyak na ang piniling daan ay nag-aalok ng pinakamakatwirang pagkakataon para sa long-term na kaginhawaan at function.

Kailan kumonsulta sa doktor

Ang Kienböck’s disease ay isang bihirang kondisyon na nakakaapekto sa mga buto ng pulso. Karaniwan itong lumalala sa paglipas ng panahon, na maaaring magdulot ng mga advanced na pagbabago sa kasu-kasuan. Dahil ang eksaktong sanay ay malamang ay kumplikado at nag-iiba-iba sa bawat tao, ang maagang pagsusuri ay tumutulong sa pamamahala ng mga sintomas. Kumonsulta sa iyong GP kung mayroon kang patuloy na sakit na hindi gumagaling kahit pahinga. Humingi ng review mula sa espesyalista kung mapapansin mo ang kahinaan, kawalan ng katatagan, o kung ang iyong pulso ay nakakabit o biglang nagwawala. Humingi ng tulong kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho, o kung ikaw ay nakakaranas ng biglang paglala ng sakit. Ang maagang pagsusuri ay nagbibigay-daan sa iyong surgeon na tukuyin ang pinakamainam na landas para sa iyong partikular na sitwasyon.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Scaphocapitate arthrodesis yields discouraging functional outcomes in the medium-term follow-up for advanced stages of Kienböck disease [1].
Scaphocapitate arthrodesis demonstrates long-term clinical benefits for the treatment of collapsed Kienböck disease [5].
Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [3].
Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, although approximately one in eight patients undergo salvage surgery [8].
Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease [9].
Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, which should be considered before any surgical intervention [11].
Capitate shortening is a safe and effective approach for the treatment of early stages of Kienböck's disease and can be associated with a satisfying outcome [13].
Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes despite widespread changes in the bones and joints within the wrist [16].
Advanced Kienböck's disease with carpal collapse is not a contraindication for carpal-sparing surgery via radial shortening osteotomy [21].
Radial shortening osteotomy offers at least comparable outcomes with proximal row carpectomy in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction [22].

Anatomy & Pathophysiology

Wrist movement can reduce blood flow to the lunate bone [57].
The number of fractures does not correlate with carpal collapse, as fragmentation can occur early in the disease process [62].

Classification

The natural history of Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [4].
Kienböck's disease progresses substantially faster than previously described [6].
Contrary to current classifications, the articular cartilage of the lunate degenerates in early stages of Kienböck's disease [6].
Lunate morphology may affect the severity of Kienböck's disease at the time of initial presentation [10].
The Lichtman et al. classification for Kienböck's disease has good reliability and reproducibility [34].
The diagnosis of Kienböck's disease in the precollapse stages is not well defined, as evidenced by substantial interobserver variability on radiographs and magnetic resonance imaging [26].
Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease [15].
A unified classification and treatment algorithm coordinates osseous, vascular, and articular data alongside patient age to allow for more precise and individualized treatment plans [12].
A new treatment algorithm integrates traditional osseous classification with perfusion/viability and articular cartilage-based classifications [35].
The Bain and Begg arthroscopic classification and an articular-based approach to Kienböck's disease provide a high probability of good long-term relief of pain and a minimal chance of requiring a salvage procedure [44].

Clinical Presentation

Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [4].
The diagnosis of Kienböck's disease in the precollapse stages is not well defined, as evidenced by substantial interobserver variability among surgeons [26].
Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of the pathology of the disease [36].
Care should be taken to address dynamic pathology, not just the stage of the disease, when planning surgical treatment for Kienböck's disease [37].

Investigations

Computed tomography of the lunate is an important investigative tool in Kienböck's disease [43].
CT imaging is significantly more accurate than conventional radiography (CR) in determining the exact stage of Kienböck's disease [47].
Proton density–weighted MRIs reflect the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses [45].
Fast-field echo images using a 47-mm microscopy coil do not reflect the extent and localization of the necrotic area in Kienböck-diseased lunates [45].

Treatment

Non-Operative Management

Nonoperative treatments are effective for children, adolescents, and elderly patients with Kienböck disease and should be considered before any surgical intervention [11].
Good and excellent clinical and radiological outcomes can be achieved with nonsurgical treatments in skeletally immature patients with Kienböck disease [9].
There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease, and many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention [38].

Early-Stage Disease Interventions

Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome [13].
Core decompression resulted in pain relief, radiological stability, and MRI normalization at 7-year follow-up in a case of early-stage Kienböck's disease, supporting the potential of disease-modifying treatments in early stages [18].
Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up [39].

Radial Osteotomies

Radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease [3].
Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, though approximately one in eight patients underwent salvage surgery [8].
Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease [17].
Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy [21].
Radial shortening osteotomy offers at least comparable outcomes with proximal row carpectomy (PRC) in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction [22].

Vascularized Bone Grafting

Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment [14].
The treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and needs no other additional procedures [48].

Salvage and Fusion Procedures

Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength [20].
Scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease given the significant postoperative reduction in associated pain symptoms at the time of follow-up [51].
Functional outcomes in medium-term follow-up are discouraging after scaphocapitate arthrodesis for advanced stages of Kienböck disease [1].
The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated [5].

Adolescent-Specific Management

Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
Surgical management of Kienböck's disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management [25].

Complications

Scaphocapitate arthrodesis for advanced stages of Kienböck disease yields discouraging functional outcomes in medium-term follow-up [1].
Approximately one in eight patients with symptomatic Kienböck's disease undergo salvage surgery after radial shortening osteotomy [8].

Recovery

Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [3].
Long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated [5].
Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function [8].
Approximately one in eight patients undergoing radial shortening osteotomy for symptomatic Kienböck's disease underwent salvage surgery [8].
Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [10].
Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes despite widespread changes in the bones and joints within the wrist [16].
Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time [19].
Additional long-term study is needed to confirm the longitudinal relationship of negative ulnar variance with progressive Kienböck disease [27].
The longer-term results of titanium lunate arthroplasty (TLA) for stage III Kienböck disease are promising [28].
The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief [29].
Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment [30].
Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease [32].
There are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease [32].
Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term [40].

Key Evidence

[L4] Nonetheless, functional outcomes in medium-term follow-up are discouraging after scaphocapitate arthrodesis for advanced stages of Kienböck disease. [1] (10.1016/j.jhsa.2013.08.063)
[L4] The current results indicate that radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease. [3] (10.1097/01.blo.0000173254.46899.72)
[L5] The natural history of Kienbock's disease is not fully known, though it is generally considered a progressive condition that can end in Stage IV changes; treatment strategies focus on biomechanical unloading, vascularized bone grafts, or salvage procedures depending on the stage. [4] (10.1016/j.hcl.2006.07.003)
[L4] The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated. [5] (10.1177/1753193413496177)
[L4] Kienböck's disease progresses substantially faster than previously described and, contrary to current classifications, the articular cartilage of the lunate degenerates in early stages. [6] (10.1016/j.jhsa.2014.06.032)
[L4] We therefore recommend this procedure for the surgical treatment of adolescent Kienböck's disease. [7] (10.1016/j.jhsa.2008.09.019)
[L4] Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, though approximately one in eight patients underwent salvage surgery. [8] (10.1055/s-0040-1714750)
[L4] Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease. [9] (10.1016/j.jhsa.2018.02.029)
[L3] Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. [10] (10.1016/j.jhsa.2014.12.024)
[L4] Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention. [11] (10.2106/jbjs.24.01090)
[L5] The authors propose a unified classification and treatment algorithm that coordinates osseous, vascular, and articular data alongside patient age to allow for more precise and individualized treatment plans for Kienböck disease. [12] (10.1016/j.jhsa.2022.03.014)
[L2] Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome. [13] (10.1177/15589447221081564)
[L3] Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment. [14] (10.1016/j.jhsa.2013.02.010)
[L3] Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease. [15] (10.1177/17531934231153966)
[L4] Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes, despite widespread changes in the bones and joints within the wrist. [16] (10.1177/1753193412471183)
[L4] Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease. [17] (10.1177/1753193413512222)
[L5] The article presents a case of early-stage Kienböck's disease where core decompression resulted in pain relief, radiological stability, and MRI normalization at 7-year follow-up, supporting the potential of disease-modifying treatments in early stages. [18] (10.1177/17531934221146851)
[L4] Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time. [19] (10.1016/j.jhsa.2007.11.005)
[L4] Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. [20] (10.1016/j.jhsg.2023.03.014)
[L4] Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy. [21] (10.1055/s-0039-1688947)
[L4] Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction. [22] (10.1016/j.jhsa.2026.02.031)
[L4] Surgical management of Kienböck ' s disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management. [25] (10.1055/s-0040-1701511)
[L4] Surgeons should be aware that the diagnosis of Kienböck disease in the precollapse stages is not well defined, as evidenced by the substantial interobserver variability. [26] (10.1177/1558944716677538)
[L2] Additional long-term study is needed to confirm the longitudinal relationship of negative ulnar variance with progressive Kienböck disease. [27] (10.1016/j.jhsa.2017.06.107)
[L4] The longer-term results of TLA for stage III Kienböck disease are promising. [28] (10.1016/j.jhsa.2018.02.009)
[L3] The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief. [29] (10.1097/blo.0b013e318041d309)
[L4] Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment. [30] (10.1016/j.jhsa.2016.02.016)
[L4] Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease and there are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease. [32] (10.1016/j.jhsa.2010.02.002)
[L4] The Lichtman et al. classification for Kienböck's disease has good reliability and reproducibility. [34] (10.1177/1753193410373862)
[L5] The manuscript reviews recent advances in diagnostics, classification, and treatment options for Kienböck disease to present a new treatment algorithm that integrates traditional osseous classification with perfusion/viability and articular cartilage-based classifications. [35] (10.1016/j.jhsa.2016.02.013)
[L3] Dorsal wrist swelling in Kienböck ' s disease is a common manifestation and constitutes a part of pathology of Kienböck ' s disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck ' s disease. [36] (10.1055/s-0038-1661420)
[L4] Care should be taken to address dynamic pathology, not just the stage of the disease, when planning surgical treatment for Kienbock's disease. [37] (10.1177/1753193420987790)
[L5] There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease, and many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention. [38] (10.1016/j.jhsa.2009.10.013)
[L4] Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. [39] (10.1016/j.jhsa.2023.02.011)
[L4] Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. [40] (10.1177/1753193417739247)
[L4] Computed tomography of the lunate in Kienböck disease is an important investigative tool. [43] (10.1016/j.jhsa.2018.05.008)
[L4] This study confirms that the Bain and Begg arthroscopic classification and an articular-based approach to Kienböck disease provide a high probability of good longterm relief of pain and a minimal chance of requiring a salvage procedure. [44] (10.1016/j.jhsa.2020.11.004)
[L4] Proton density–weighted MRIs but not fast-field echo images using a 47-mm microscopy coil reflected the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses of the lunate specimens. [45] (10.1016/j.jhsa.2011.09.027)
[L3] CT imaging is significantly more accurate than CR in determining the exact stage of Kienböck's disease. [47] (10.1177/17531934241286115)
[L4] The treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and needs no other additional procedures. [48] (10.1007/s00402-008-0586-x)
[L4] Given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease. [51] (10.1007/s11552-014-9705-z)
[L4] Wrist movement can reduce blood flow to the lunate bone. [57] (10.1186/s12891-019-2492-5)
[L4] The number of fractures does not correlate with carpal collapse, as fragmentation can occur early in the disease process. [62] (10.1055/s-0039-1688993)

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