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CC BY-NC-ND 4.0 · J Hand Microsurg 2023; 15(02): 087-097
DOI: 10.1055/s-0041-1730888
Review Article

Matching Kienböck's Treatment Options to Specific Features of Each Case

Mark Henry
1   Hand and Wrist Center of Houston, Houston, Texas, United States
,
Forrest H. Lundy
1   Hand and Wrist Center of Houston, Houston, Texas, United States
,
Giselle K. Henry
1   Hand and Wrist Center of Houston, Houston, Texas, United States
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Abstract

Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck's patients through the early, transitional, and late phases of the disease.

Keywords

Kienböck's treatment - revascularization - flap - osteotomy - prosthesis - fusion


Publication History

Article published online:
19 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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