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Kienbock's Disease Classification

Kienbocks disease stage 1   Stage 1
  • The lunate appears normal on xray or there may be a nondisplaced fracture; MRI demonstrates loss of signal consistent with osteonecrosis.
  • Treatment: spinting, activity modifications, NSAIDs
  • Consider ulnar lengthening or radial shortening for patients with negative ulnar variane.
Kienbock's Disease  Stage 2

Stage 2

  • Increased lunate radiodensity without loss of contour; lunate not collapsed.
  • Treatment: 4 + 5 extensor compartmental vascularized bone graft. (Moran CL, J Hand Surg 2005;30A:50).
Kienbock's Disease Stage 3A

Stage 3A

  • Increased lunate radiodensity and fragmentation without loss of carpal height.
  • Treatment: 4 + 5 extensor compartmental vascularized bone graft. (Moran CL, J Hand Surg 2005;30A:50).
  • Consider scaphocapitate arthrodesis, or scaphotrapeziotrapezoid arthrodesis
Kienbocks Disease Stage 3B

Stage 3B

  • Lunate fragmentation with proximal migration of the capitate and rotation of the scaphoid.
  • Treatment: scaphocapitate arthrodesis, or scaphotrapeziotrapezoid arthrodesis
  • Consider Proximal Row Carpectomy
Kienbock's Disease Stage 4

Stage 4

  • Lunate severely collapsed and fragmented, secondary arthritic changes in the wrist.
  • Treatment: Proximal Row Carpectomy.
  • Consider: scaphocapitate arthrodesis, and scaphotrapeziotrapezoid arthrodesis.