Treatment of Kienbock Disease with Carpal Collapse and Radioscaphoid Angle Greater Than 60 Degrees

This protocol addresses adult patients (ages 21–69) with advanced Kienbock disease in which carpal collapse has progressed to involve the radial column, with a radioscaphoid angle exceeding 60 degrees.

Clinical scenario

Age 21–69 years
Carpal collapse with radioscaphoid angle greater than 60 degrees
Functional radioscaphoid articulation
Lichtman stage IIIB or IIIC
Schmitt MRI stage B
Bain arthroscopic grade 2 to 4

In this setting, management centres on stabilizing the radial column. A targeted carpal fusion procedure is a key consideration — but which approach applies, and under what conditions, is determined by the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1055/s-0037-1604137

For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
With collapse and/or degeneration of the central column, it is common for the radial column to also collapse (e.g., radioscaphoid angle is greater than 60 degrees).
Fortunately, the radioscaphoid articulation often remains functional, so a scaphocapitate fusion can be performed.
A STT fusion is an alternative.

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