Treatment of Kienböck Disease with Non-Reconstructable Lunate in Adults Aged 21 to 69
Clinical Scenario
This protocol addresses adults between 21 and 69 years of age with Kienböck disease in which the lunate is no longer reconstructable — defined as a lunate that is fragmented, has collapsed, or has completely lost its vascular supply. At this stage, the lunate articular surfaces are nonfunctional and revascularisation is not a viable path.
Staging
This scenario corresponds to advanced disease confirmed across multiple classification systems:
Lichtman Stage IIIC
Schmitt MRI Stage C
Bain Arthroscopic Grade 2b
Treatment Direction
When the lunate is not reconstructable, a lunate salvage procedure is required. Proximal row carpectomy is one described option, applicable under specific conditions relating to the integrity of adjacent articular surfaces. Additional surgical approaches exist depending on the carpal anatomy at time of intervention — the full decision algorithm and criteria for selecting among them are available in the complete protocol.
The complete approach, including all indicated options and selection criteria, is in the structured protocol below.
References
DOI: 10.1055/s-0037-1604137
- For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
- A lunate is "not reconstructable" if it is fragmented, collapsed, or has completely lost its vascular supply.
- The lunate is not reconstructable if the lunate has collapsed, has no revascularization potential or the lunate articular surfaces are nonfunctional.
- Then a salvage procedure of the lunate is required.
- If the lunate is not reconstructable, then it needs to be excised.
- Proximal row carpectomy is a time tested technique that is indicated for the unreconstructable lunate if the articular surfaces of the lunate facet and the capitate are functional (Bain grade 2b).
View source ↗