Treatment of avascular necrosis of the lunate (Kienböck’s disease): a review of current literature

Abstrakt

Kienböck’s disease is classified in the category of aseptic bone necrosis. It develops as a consequence of compromised blood supply to the bone, but its aetiology remains obscure. Vascular network supplying of the lunate is relatively delicate and in some anatomical variants is susceptible to damage.
The paper provides relatively new information about treatment options used in Kienböck’s disease. Despite numerous studies, no commonly accepted algorithm has been developed. The choice of treatment method is dependent on the degree of destruction of the lunate and arthritis in carpal joints. Conservative treatment by wrist immobilization is generally used in the early stages of Kienböck’s disease, because it reduces pressure on the bone and improves blood supply. Operative treatment generally refers to a symptomatic disease when conservative treatment has proven ineffective or when there are unfavourable anatomical conditions such as ulna minus variant. In general, treatment methods are divided into 3 groups: improving blood supply (revascularization), reducing pressure on the lunate (shortening osteotomy of the radius or capitate, and partial wrist fusion) and “wrist salvage” operations (wrist denervation, proximal row carpectomy, total wrist fusion). All these techniques are described and their effectiveness is discussed in the article.