When both the radiolunate and midcarpal articulations are nonfunctional in an adult aged 21–69 years, Kienbock disease has progressed to a stage where advanced staging criteria across imaging and arthroscopic grading converge. A specific surgical strategy applies in this scenario.
This protocol applies to patients aged 21–69 years presenting with all of the following:
At this stage, the central column of the wrist is the focus of the surgical decision. The approach involves bypassing the central column — the specific procedure selected depends on the condition of the adjacent articular surfaces.
The complete surgical algorithm, indications for each option, and procedural details are available in the full structured protocol.
DOI: 10.1055/s-0037-1604137
For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
C.1.b: Radiolunate and midcarpal articulations nonfunctional (Lichtman stage IIIA or C, Schmitt stage C, and Bain grade 4).
The central column is not reconstructable and can be bypassed with a scaphocapitate fusion.
Occasionally, the capitate articular surface is intact (Lichtman stage IIIA or C, Schmitt stage C, and Bain grade 3), so a hemiarthroplasty can be performed.
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