Kienbock Disease in Adults Aged 21–69 with Nonfunctional Radiolunate Articulation of the Wrist

This protocol applies to patients aged 21 to 69 years with Kienbock disease in whom the radiolunate articulation is no longer functional — classified as Lichtman stage IIIA, Schmitt MRI stage B, and Bain arthroscopic grade 2a — while the midcarpal joint surfaces remain intact and functional.

Clinical scenario: Adults aged 21–69 years, nonfunctional radiolunate articulation (Lichtman stage IIIA, Schmitt stage B, Bain grade 2a), with functional midcarpal joint surfaces.

Management centres on surgical intervention to address the compromised radiolunate joint — either by fusion or by bypassing that articulation. Multiple recognised surgical approaches exist; the complete protocol specifies which to select and under what circumstances.

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.
C.1.a: Radiolunate articulation compromised (Lichtman stage IIIA, Schmitt stage B, and Bain grade 2a) and the midcarpal joint surfaces functional.
A RSL fusion can be performed.
Note these alternatives are more destructive than an isolated lunate reconstruction.

View source ↗