Review Question - QID 217386

Kienbock's Disease QID: 217386 (OBQ21.67)

QID 217386 (Type "217386" in App Search)

Figure A is the radiograph of a 54-year-old male presenting with wrist pain. He reports that he underwent surgical intervention approximately 15 years ago for "carpal osteonecrosis." Which carpal bone ossifies at 2-4 years of age and is likely responsible for the prior surgical intervention in this patient as depicted in Figure B?

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1263/1354

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This patient likely had Kienbock's Disease treated with a proximal row carpectomy (PRC). Kienbock's Disease is avascular necrosis of the lunate (E).

Kienbock's Disease is avascular necrosis of the lunate which can lead to progressive wrist pain and abnormal carpal motion. Diagnosis can be made with wrist radiographs in advanced cases but may require MRI for detection of early disease. Treatment is usually NSAIDs and observation in minimally symptomatic patients. A variety of operative procedures are available depending on the severity of the disease and the patient's symptoms.

Innes et al. performed a systematic review of the treatment of Kienböck's disease to test the hypothesis that none of the reported treatments for Kienböck's disease are superior with respect to outcomes of pain, motion, grip strength, and radiographic measures. They reported no statistically significant difference between any of the treatment groups for subjective pain outcomes. They concluded that based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease and there are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease.

Lichtman et al. reviewed Kienböck's disease. They reported that information has been reported regarding etiology, natural history, classification, and treatment options for lunate osteonecrosis. They present a treatment algorithm that incorporates the traditional osseous classification system with a perfusion/viability classification and an articular cartilage-based classification.

Figure A is the radiograph of the wrist following a proximal row carpectomy. Figure B is the unlabeled carpal bones. Illustration A is the corresponding labeled carpal bones.

Incorrect Answers:
Answer 1: This is the Hook of the Hamate and ossifies at 2-4 months
Answer 2: This is the Hamate and ossifies at 2-4 months
Answer 3: This is the Pisiform and ossifies at 8-12 years
Answer 4: This is the Triquetrum and ossifies at 2-3 years but rarely involved in osteonecrosis requiring PRC