Bệnh Kienböck Thông tin

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

[9] Kienböck Disease in the Skeletally Immature Patient. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.029

[10] The Effect of Lunate Morphology in Kienböck Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.024

[11] Kienböck Disease: Recent Advances in Understanding and Management. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01090

[12] Precision Medicine for Kienböck Disease in the 21st Century. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.03.014

[13] Comparing the Radiologic and Functional Outcome of Radial Shortening Versus Capitate Shortening in Management of Kienböck’s Disease. HAND. 2022. DOI: 10.1177/15589447221081564

[14] Long-Term Results of Vascularized Bone Graft for Stage III Kienböck Disease. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.010

[15] Diagnostic performance of traditional radiographic indices in detection of carpal collapse in Kienböck’s disease. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231153966

[16] Long-term clinical results and MRI changes after tendon ball arthroplasty for advanced Kienböck’s disease. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412471183

[17] Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck’s lunatomalacia. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413512222

[18] Kienböck’s disease: preventing disease progression in early-stage disease. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221146851

[19] Long-Term Subjective and Radiological Outcome After Reconstruction of Kienböck’s Disease Stage 3 Treated by a Free Vascularized Iliac Bone Graft. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.11.005

[20] Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.014

[21] Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688947

[22] Save or Salvage: Radial Shortening Osteotomy and Proximal Row Carpectomy in Kienböck’s Disease—A Descriptive Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.02.031

[25] Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1701511

[26] Interobserver Agreement in Diagnosing Early-Stage Kienböck Disease on Radiographs and Magnetic Resonance Imaging. HAND. 2016. DOI: 10.1177/1558944716677538

[27] Risk Factors of Lunate Collapse in Kienböck Disease. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.107

[28] Long-Term Clinical Outcome After Titanium Lunate Arthroplasty for Kienböck Disease. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.009

[29] Outcome of Kienböck's Disease 22 Years after Distal Radius Shortening Osteotomy. Clinical Orthopaedics & Related Research. 2007. DOI: 10.1097/blo.0b013e318041d309

[30] Radiographic Progression of Kienböck Disease: Radial Shortening Versus No Surgery. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.02.016

[32] Systematic Review of the Treatment of Kienböck's Disease in Its Early and Late Stages. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.02.002

[34] Reliability and reproducibility of Kienböck’s disease staging. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410373862

[35] Kienböck Disease: Moving Forward. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.02.013

[36] Wrist Swelling in Kienböck's Disease. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1661420

[37] Kinematics of the wrist in Kienböck’s disease: a four-dimensional computed tomography study. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193420987790

[38] Kienböck's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.10.013

[39] Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.02.011

[40] Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417739247

[43] Fixation of the Fractured Lunate in Kienböck Disease. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.05.008

[44] Long-Term Outcome of Surgical Treatment for Kienböck Disease Using an Articular-Based Classification. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.11.004

[45] Correlation of Histopathology With Magnetic Resonance Imaging in Kienböck Disease. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.027

[47] Radiography versus computed tomography for osseous staging of Kienböck’s disease. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241286115

[48] The treatment of Kienböck disease with vascularized bone graft from dorsal radius. Archives of Orthopaedic and Trauma Surgery. 2008. DOI: 10.1007/s00402-008-0586-x

[51] Limited Intercarpal Fusion as a Salvage Procedure for Advanced Kienbock Disease. HAND. 2014. DOI: 10.1007/s11552-014-9705-z

[57] Superselective angiography of the wrist in patients with Kienböck’s disease. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2492-5

[62] Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688993