Kienbock's Disease

Osteonecrosis of the lunate, Kienbock's disease, is a progressive, debilitating disease process that can lead to chronic pain and dysfunction. Despite its recognition almost 100 years ago, the etiology remains unidentified, although mechanical, vascular, and traumatic factors have been implicated. The natural history of this disease is poorly defined, and the radiographic appearance does not always correlate with the clinical findings, Some progress has been made in the identification and an understanding of the progression of the avascular process and its deleterious effects on wrist mechanics. Initial treatment is nonsurgical. Advances in surgical techniques with vascularized pedicled grafts from the distal radius may lead to an improvement in outcomes for patients in the earlier stages of disease, although much more work is needed to determine whether this surgical option represents an improvement over conventional treatment alternatives. Recent reports of long-term outcomes of radial shortening osteotomy for earlier stages of osteonecrosis and proximal row carpectomy for advanced Kienbock's disease reveal that these procedures provide reliable options for the long-term management of this difficult clinical problem. (J Hand Surg 2009;34A:167-175. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)