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KIENBOCK’S DISEASE

KIENBOCK’S DISEASE. ETIOLOGY CLASSIFICATION DIAGNOSIS TREATMENT OUTCOME. KIENBOCK’S DISEASE. KIENBOCK’S DISEASE. BLOOD SUPPLY TRAUMA ULNA MINUS LUNATE SHAPE. Blood Supply. Dorsal aspect. Volar Aspect. Intraosseous Circulation. Lunate Fracture. Ulnar Variance. Diagnosis.

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KIENBOCK’S DISEASE

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  1. KIENBOCK’S DISEASE • ETIOLOGY • CLASSIFICATION • DIAGNOSIS • TREATMENT • OUTCOME

  2. KIENBOCK’S DISEASE

  3. KIENBOCK’S DISEASE • BLOOD SUPPLY • TRAUMA • ULNA MINUS • LUNATE SHAPE

  4. Blood Supply Dorsal aspect Volar Aspect

  5. Intraosseous Circulation

  6. Lunate Fracture

  7. Ulnar Variance

  8. Diagnosis • radiographic • young adults • pain , stiffness . tenderness • marked loss of grip strength

  9. Diagnosis • early - Xrays normal • MRI • Bone Scan • CT

  10. Diagnosis • AVN on MRI - low signal on T1 & T2 • MRI helps to differentiate Kienbocks from other causes of radiolucency in lunate • Bone scan : increased uptake

  11. MRI

  12. Classification:Lichtmann Staging • Stage 1 Normal Xray,MRI/Bone scan+ve • Stage 2 Abnormal density • Stage 3a lunate collapse • Stage 3b carpal collapse • Stage 4 osteoarthritis

  13. Staging

  14. Carpal Angles

  15. Carpal Angles 47 degrees(30-60) 0 degrees(+/- 15)

  16. Carpal Height L2/L1 = 0.54+/-0.03 REVISED CARPAL HEIGHT RATIO =L2/CAPITATE LENGTH = 1.57 +/- 0.05

  17. Treatment • natural history unclear • some studies suggest nonoperative treatment better • others show arthritic changes 60 - 80 % of nonoperatively treated patients • Xrays progress but symptoms may not

  18. Treatment : Surgical • lunate resection & arthroplasty • STT or capitate-hamate arthrodesis • wrist levelling procedures-radial,ulnar • Capitate shortening • vascularised bone grafts +/- Ex-Fix • Ex-Fix + cancellous graft

  19. Wedge Osteotomy

  20. STT Fusion

  21. STT Fusion Graft Site

  22. STT Fusion

  23. Vascularised Bone Graft

  24. Salvage procedures • Wrist arthrodesis • Proximal row carpectomy • Wrist arthroplasty - not

  25. Wrist Fusion

  26. What I do • treat conservatively after patient education • Stage 1 - 3 & ulna minus : Radial shortening • Stage 1 - 3 & ulna neutral : STT • Stage 4 : arthrodesis

  27. Kienbock’s disease • Outcome wrist-levelling • Pain relief : 70-80 % • Grip strength : 30-50% • Xray : no improvement or deterioration • ?ROM • ?MRI

  28. THE END

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