kienbocks - KIENBOCK’S DISEASE KIENBOCK’S DISEASE •...

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Unformatted text preview: KIENBOCK’S DISEASE KIENBOCK’S DISEASE • • • • • ETIOLOGY CLASSIFICATION DIAGNOSIS TREATMENT OUTCOME KIENBOCK’S DISEASE KIENBOCK’S DISEASE KIENBOCK’S DISEASE KIENBOCK’S DISEASE • • • • BLOOD SUPPLY TRAUMA ULNA MINUS LUNATE SHAPE Volar Aspect Blood Supply Blood Supply Dorsal aspect Intraosseous Circulation Intraosseous Circulation Lunate Fracture Ulnar Variance Ulnar Variance Diagnosis Diagnosis • • • • radiographic young adults pain , stiffness . tenderness marked loss of grip strength Diagnosis Diagnosis • • • • early ­ Xrays normal MRI Bone Scan CT Diagnosis 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 MRI MRI Classification: 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 Staging Staging Carpal Angles Carpal Angles Carpal Angles Carpal Angles 47 degrees(30-60) 0 degrees(+/- 15) Carpal Height Carpal Height L2/L1 = 0.54+/-0.03 REVISED CARPAL HEIGHT RATIO =L2/CAPITATE LENGTH = 1.57 +/- 0.05 Treatment 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 Treatment : Surgical Treatment : Surgical • • • • • • lunate resection & arthroplasty STT or capitate­hamate arthrodesis wrist levelling procedures­radial,ulnar Capitate shortening vascularised bone grafts +/­ Ex­Fix Ex­Fix + cancellous graft Wedge Osteotomy Wedge Osteotomy STT Fusion STT Fusion STT Fusion Graft Site STT Fusion Graft Site STT Fusion STT Fusion Vascularised Bone Graft Vascularised Bone Graft Salvage procedures Salvage procedures • • • Wrist arthrodesis Proximal row carpectomy Wrist arthroplasty ­ not Wrist Fusion Wrist Fusion What I do What I do • • • • treat conservatively after patient education Stage 1 ­ 3 & ulna minus : Radial shortening Stage 1 ­ 3 & ulna neutral : STT Stage 4 : arthrodesis Kienbock’s disease Kienbock’s disease • Outcome wrist­levelling – – – – – Pain relief : 70­80 % Grip strength : 30­50% Xray : no improvement or deterioration ?ROM ?MRI THE END THE END ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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