Treatment of Kienböck Disease in Adults Aged 21–69 with Intact Lunate
This protocol covers first-line management of Kienböck disease in patients aged 21 to 69 years who present with an intact lunate at early-stage radiological and arthroscopic classification.
Clinical Scenario
The lunate is considered intact when it is not fractured and its articular surfaces are functional. This scenario applies across Lichtman stages 0, I, and II, Schmitt MRI stage A, and Bain arthroscopic grade 0 — all representing an intact lunate.
Age 21–69 years
Intact lunate
Lichtman Stage 0 / I / II
Schmitt MRI Stage A
Bain Arthroscopic Grade 0
Treatment Approach — Partial Overview
At this early stage, management is nonoperative, centred on wrist immobilisation and activity modification. Any underlying medical contributors to osteonecrosis are addressed in parallel. The complete regimen — specific immobilisation method, activity guidance, and escalation criteria — is available in the full protocol.
Treatment Goals
- Resolution of wrist pain
- No lunate collapse progression on imaging at 3 months
References
DOI: 10.1055/s-0037-1604137
- For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
- The lunate is "intact" if it is not fractured and the articular surfaces are "functional."
- Lichtman stages 0, I, and II, Schmitt stage A, and Bain grade 0 all represent an intact lunate.
- In the earliest stages, patients are managed nonoperatively for at least 3 months (e.g., short arm cast or splint), however, minimally invasive techniques may be appropriate as well.
- Patients are advised to avoid strenuous activities or lifting over 5 kg (10 lb).
- Medical causes of osteonecrosis should be treated.
- If the patient is symptomatic after 3 months, or imaging demonstrates disease progression, a lunate unloading or revascularization procedure is considered.
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