Kienbock’s Disease : Mnemonic Approach

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


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