Doença de Kienböck Folheto

O que você está sentindo

Você pode notar uma dor surda ou aguda no lado do polegar do seu pulso. Esta é a área onde o osso escafoide (lunatum) fica localizado no centro da sua articulação do pulso. A dor geralmente começa gradualmente. Pode parecer uma simples distensão no início. Com o tempo, a condição é geralmente considerada progressiva. Isso significa que os sintomas podem piorar se não forem tratados.

Seu pulso pode parecer rígido, especialmente pela manhã. Você pode notar inchaço ao redor da área dolorida. Movimentos simples podem se tornar difíceis. Alcançar as costas para fechar um sutiã pode causar dor. Enfiar a camisa pode ser desconfortável. Levantar objetos, mesmo os leves, pode desencadear uma crise. A dor geralmente aumenta após a atividade. Você pode senti-la mais no final do dia.

Algumas pessoas acham a dor pior à noite. Dormir do lado afetado pode ser particularmente desconfortável. Você pode acordar com o pulso rígido e dolorido. Descansar a mão em posição neutra geralmente ajuda a aliviar a pressão. No entanto, a história natural desta condição não é totalmente conhecida. Isso significa que não podemos prever exatamente como seus sintomas mudarão ao longo do tempo.

A gravidade da sua dor no início pode depender da forma do seu osso lunatum. Algumas estruturas ósseas são mais propensas a alterações precoces. Como os raios-X tradicionais frequentemente não detectam sinais precoces de colapso, seus sintomas são um guia fundamental. Você pode sentir uma sensação de clique ou atrito ao mover o pulso. Isso ocorre devido ao deslocamento dos ossos de seu alinhamento normal.

É comum sentir frustração com a imprevisibilidade da dor. Você pode se perguntar por que alguns dias são melhores que outros. O desenvolvimento da doença de Kienböck provavelmente é multifatorial. Isso significa que vários fatores contribuem para ela, não apenas uma causa. Compreender seus sintomas nos ajuda a escolher o tratamento adequado para você. Seja necessário repouso, uso de talas ou cirurgia, o objetivo é reduzir essa dor e restaurar a função.

O que está realmente acontecendo

O seu pulso é composto por oito pequenos ossos chamados carpos. Eles se empilham em duas fileiras para conferir força e flexibilidade à sua mão. Na doença de Kienböck, um desses ossos, o escafoides (lunatum), perde o suprimento sanguíneo. Sem sangue, o tecido ósseo começa a morrer. Esse processo é chamado de necrose avascular.

À medida que o osso morre, ele perde a resistência. Não consegue mais suportar a carga diária dos seus movimentos. Com o tempo, o escafoides amolece e colapsa. Esse colapso altera a forma como os outros ossos do seu pulso se movem uns em relação aos outros. O movimento suave de deslizamento torna-se áspero e irregular.

Essa alteração estrutural causa seus principais sintomas. Os ossos desalinhados esfregam uns contra os outros, gerando dor e rigidez. Você pode sentir uma sensação de atrito ao mover o pulso. A instabilidade também pode enfraquecer a sua força de preensão. O seu cirurgião explica que isso não é apenas um desgaste superficial. É uma falha estrutural profunda no núcleo da articulação.

Tratamos isso restaurando o equilíbrio da fileira carpal. Nos casos avançados, podemos remover o escafoides danificado. Em seguida, estabilizamos os ossos remanescentes usando enxertos de tendão ou técnicas de fusão. Esses procedimentos restauram a integridade da fileira carpal proximal. Isso ajuda o seu pulso a se mover suavemente novamente.

Para pacientes mais jovens, frequentemente utilizamos enxertos ósseos para suportar o osso em processo de morte. Isso pode interromper o colapso e preservar o movimento. Em alguns casos, encurtamos o osso rádio para reduzir a pressão sobre o escafoides. Esse ajuste simples pode melhorar os resultados por até uma década em 75% dos pacientes.

Nosso objetivo é sempre proteger as superfícies articulares saudáveis remanescentes. Ao corrigir o alinhamento, reduzimos o estresse anormal sobre a cartilagem. Isso ajuda a prevenir a progressão da artrite. Adaptamos cada plano à sua idade e nível de atividade. Seja você precise de uma correção temporária ou de uma reconstrução permanente, nosso objetivo é restaurar a função e aliviar a dor.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, aborda este tema em nossa clínica ao adequar o tratamento ao estágio da sua condição. Os pacientes chegam à nossa clínica por encaminhamento do clínico geral ou fisioterapeuta. Uma avaliação na clínica estabelece o diagnóstico. Para problemas degenerativos ou de longa data, geralmente tentamos primeiro o tratamento não cirúrgico. Para problemas estruturais ou agudos, a cirurgia pode ser recomendada imediatamente.

Você pode começar com automaneio e fisioterapia. A mudança de atividades ajuda a reduzir o estresse no punho. A fisioterapia visa manter a mobilidade e fortalecer os músculos ao redor. A imobilização pode apoiar o punho durante as tarefas diárias. Geralmente sugerimos dar uma chance justa a essa abordagem para verificar se ela reduz sua dor e melhora a função antes de considerar etapas adicionais.

O tratamento médico concentra-se no controle dos sintomas. Medicamentos para dor e anti-inflamatórios podem ajudar a gerenciar o desconforto. Injeções, como cortisona, podem reduzir a inflamação e a dor por um período limitado. Injeções de ácido hialurônico ou plasma rico em plaquetas (PRP) às vezes são consideradas para apoiar a saúde articular, embora a duração do benefício varie. Essas opções visam mantê-lo confortável enquanto monitoramos a progressão da doença.

A cirurgia é considerada quando o tratamento conservador não proporcionou melhora suficiente ou se a doença está avançada. Nosso objetivo é aliviar a dor e preservar a função do punho. As opções variam de procedimentos que aliviam a carga óssea àquelas que fundem articulações para estabilidade. Discutimos a opção cirúrgica específica com você com base no seu estágio e objetivos, garantindo que você entenda o que a operação envolve e o que esperar durante a recuperação.

O que esperar

A doença de Kienböck é uma condição em que o suprimento sanguíneo para um pequeno osso do pulso é reduzido, causando enfraquecimento e colapso desse osso. Esse processo é geralmente progressivo, o que significa que tende a piorar ao longo do tempo se não for tratado. Nos estágios avançados, a doença pode levar a uma osteoartrite generalizada por desgaste no pulso. Como a evolução natural dessa condição não é totalmente previsível, seu cirurgião monitorará seu progresso de perto para determinar o melhor momento para a intervenção.

Sem tratamento, os sintomas frequentemente persistem e podem intensificar-se gradualmente. No entanto, com o manejo adequado, é possível obter alívio significativo. Para pacientes mais jovens, procedimentos como o realinhamento ósseo podem melhorar tanto os sintomas quanto a aparência do pulso nas radiografias no curto prazo. Para adultos mais velhos com colapso mais avançado, opções como a fusão de ossos específicos ou a remoção do osso danificado são projetadas para proporcionar benefícios a longo prazo. Essas abordagens visam interromper a progressão da doença e preservar a função.

Quando bem manejada, muitos pacientes experimentam melhorias substanciais. Por exemplo, a osteotomia de encurtamento radial — um procedimento que ajusta o comprimento do osso do antebraço — proporciona melhorias por décadas em 75% dos pacientes com doença sintomática. Outros procedimentos, como a artrodese escafo-capitata com excisão do lunato, demonstraram aliviar significativamente a dor e manter uma força de preensão satisfatória por uma média de 10,7 anos. Mesmo em casos avançados, cirurgias que poupam o carpo podem ser eficazes, e a ressecção da fileira proximal do carpo permanece como uma opção durável para manter a amplitude de movimento e a força do pulso por mais de dez anos.

É importante notar que a progressão radiográfica da doença ao longo de um ano ou mais é leve, em média, independentemente do tratamento escolhido. Isso significa que, embora as alterações estruturais subjacentes possam ser lentas, os sintomas clínicos — como dor e rigidez — são o que visamos principalmente melhorar. Seu cirurgião adaptará o plano ao estágio específico da sua doença, garantindo que o caminho escolhido ofereça a chance mais realista de conforto e função a longo prazo.

Quando procurar ajuda

A doença de Kienböck é uma condição rara que afeta os ossos do punho. Frequentemente, piora ao longo do tempo, podendo levar a alterações articulares avançadas. Como a causa exata é provavelmente complexa e varia entre as pessoas, a avaliação precoce ajuda a controlar os sintomas. Consulte o seu médico de família se tiver dor persistente que não melhora com o repouso. Solicite uma avaliação por um especialista se notar fraqueza, instabilidade, ou se o seu punho travar ou ceder. Procure ajuda se os sintomas interferirem no seu sono ou no trabalho, ou se experimentar um agravamento súbito da dor. A avaliação precoce permite que o seu cirurgião determine o melhor caminho a seguir para a sua situação específica.

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)

References

[1] Scaphocapitate Arthrodesis in the Treatment of Kienböck Disease. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.063

[3] Radial Osteotomies for Teenage Patients with Kienb??ck Disease. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000173254.46899.72

[4] Kienböck's Disease: An Approach to Treatment. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2006.07.003

[5] Scaphocapitate arthrodesis for treatment of late stage Kienböck disease. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413496177

[6] Characteristic Features and Natural Evolution of Kienböck Disease: Five Years Results of a Prospective Case Series and Retrospective Case Series of 106 Patients. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.032

[7] Temporary Scaphotrapezoidal Joint Fixation for Adolescent Kienböck's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.09.019

[8] Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1714750

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