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Mnemonics, Simplified Concepts & Thoughts

Kienbock’s Disease : Mnemonic Approach

Dr. Sulabh Kumar Shrestha, MS Orthopedics, Jul 18, 2024Jul 18, 2024

Last updated on July 18, 2024

Etiology

Mnemonic: RSTUV

  1. Radial inclination – decreased
  2. Shape of lunate (Type 1 has more proximal apex; Type 2 & 3 are more rectangular)
    • Type 1 lunate is seen with negative ulnar variance and possess highest risk of Kienbock’s disease
  3. Trauma (repetitive micro-fractures or single fracture)
  4. Ulnar variance – negative (increased radial-lunate contact stress)
  5. Vascular anatomy (3 patterns – X, Y, I)
    • “I” pattern (single vessel to lunate) – highest risk of avascular necrosis
Kienbock's disease
Negative ulnar variance with Sclerosis of lunate (Kienbock’s disease)
Muzichick, CC BY-SA 4.0, via Wikimedia Commons

Lichtman Classification and Management

StageDescriptionTreatment
Mnemonic: ABCDMnemonic: ABCD
IAbnormal MRI (decreased T1 intensity; variable T2 intensity) or scintigraphyAnalgesics + immobilization
IIBone sclerosis ± Bone breaks (fracture lines)Bony procedures:
1. Negative or Neutral ulnar variance: Joint levelling procedure (Radius shortening osteotomy; Ulnar lengthening)

2. Positive ulnar variance: Revascularization procedures (pedicled vascularized bone graft from dorsal distal radius), Distal radius core decompression, Radial wedge osteotomy
IIICollapse of wrist with:
ANormal carpal alignmentSame as stage II
BFixed scaphoid rotationCarpal fusion (STT or SC)
Carpectomy (PRC)
IVDegenerative changes of wristDeliverance (Salvage)
1. Proximal row carpectomy (PRC – allows capitate to articulate into lunate fossa)
2. Wrist arthrodesis
3. Wrist denervation
4. Total wrist arthroplasty
dr. sulabh kumar shrestha
Dr. Sulabh Kumar Shrestha, MS Orthopedics

He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.

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PGMEE, MRCS, USMLE, MBBS, MD/MS Musculoskeletal systemOrthopedics

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Shrestha SK. Kienbock’s Disease : Mnemonic Approach [Internet]. Epomedicine; 2024 Jul 18 [cited 2025 May 10]. Available from: https://epomedicine.com/medical-students/kienbocks-disease-mnemonic-approach/.

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