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

Lichtman Classification and Management

Stage	Description	Treatment
	Mnemonic: ABCD	Mnemonic: ABCD
I	Abnormal MRI (decreased T1 intensity; variable T2 intensity) or scintigraphy	Analgesics + immobilization
II	Bone 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
III	Collapse of wrist with:
A	Normal carpal alignment	Same as stage II
B	Fixed scaphoid rotation	Carpal fusion (STT or SC) Carpectomy (PRC)
IV	Degenerative changes of wrist	Deliverance (Salvage) 1. Proximal row carpectomy (PRC – allows capitate to articulate into lunate fossa) 2. Wrist arthrodesis 3. Wrist denervation 4. Total wrist arthroplasty