In adults between 21 and 69 years of age, advanced Kienböck disease collapse can reach a point where the radioscaphoid articulation is no longer functional. When pancarpal osteoarthritis is also present, this represents a distinct, late-stage clinical situation that calls for a specific course of action.
Once the radioscaphoid articulation is compromised and nonfunctional, wrist reconstruction is no longer an option. This protocol applies to the following staging profile:
At this stage the wrist is considered unreconstructable, and the protocol moves to a wrist salvage strategy. Which salvage procedure is appropriate depends on the individual patient's demands and circumstances — the full structured approach is available via the link below.
DOI: 10.1055/s-0037-1604137
For patients, 21 to 69 years, proceed to sections B or C, as appropriate.
Once the radioscaphoid articulation also becomes nonfunctional, the wrist is no longer reconstructable and a salvage procedure is required, such as total wrist fusion or total wrist arthroplasty.
Once the radioscaphoid articulation is also compromised (nonfunctional), the wrist is unreconstructable and a salvage procedure is required (e.g., very late Kienböck disease or after failed reconstructive surgery).
The recommendation will depend upon the demands of the patient.
Total wrist arthroplasty is only performed in those patients who will not overload the wrist.
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