Review Question - QID 3149

This clinical scenario and imaging studies are consistent with Kienbock's disease, avascular necrosis of the lunate, in the pre-collapse stage. Core decompression of the distal radius is an accepted treatment for Kienbock's disease. The procedure creates a local vascular healing response facilitating vascular recovery prior to collapse and degeneration of the lunate. Other acceptable interventions include revascularization with a pedicled graft and joint leveling procedures such as a radial shortening osteotomy. The radial shortening osteotomy is ideal for patients with negative ulnar variance who experience greater loads through the radiolunate fossa.

Sherman et al performed a cadaveric study demonstrating minimal change in the distribution of force between the radiocarpal fossa and ulnocarpal fossa following core decompression of the distal radius.

Illarramendi et al reviewed 22 cases of Kienbock's treated with radial and ulnar metaphyseal core decompression. No surgical complications occurred, and 20 of 22 reported satisfactory clinical outcomes while one patient developed intercarpal arthritis.

Incorrect Answers:
1. Proximal row carpectomy and wrist fusion would be options for the collapsed and degenerative lunate.
2. Ulnar shortening osteotomy and scapholunate ligament reconstruction are incorrect as they do not address the pathology of Kienbock's.
4. Proximal row carpectomy and wrist fusion would be options for the collapsed and degenerative lunate.
5. Ulnar shortening osteotomy and scapholunate ligament reconstruction are incorrect as they do not address the pathology of Kienbock's.