Title: Kienbock’s disease, Avascular Necrosis of Lunate: A Clinico-anatomical Insight
Authors: Dr Jasbir Kaur (MD, DNB, MNAMS), Dr Davinder Singh (MS, DNB, MNAMS), Dr Mangala Kohli (MD, Anatomy)
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.23
Abstract
Kienbock’s disease or lunatomalacia is a specific and very rare form of osteonecrosis affecting the lunate bone due to disruption of blood supply. The disease, rarely bilateral mainly affects young males, predominantly manual workers. The disease is manifested as insidious, progressive dorsal wrist pain surrounding lunate bone with or without associated swelling. The patient may provide a history of trauma prior to the appearance of signs and symptoms. Though, the underlying mechanisms of disease are highly controversial, all of them result in compromised blood flow leading to bone infarction and mechanical failure. Thus, emphasizing the importance of in depth knowledge of vascular anatomy of the bone. The diagnosis is based on high clinical suspicion along with radiography and MRI scanning. Modalities of treatment include immobilization with splinting or casting, mechanical unloading of lunate leading to spontaneous revascularization, bone graft procedures, proximal row carpectomy, joint replacement and carpal bone fusion in advanced cases[1]. The present report highlights a case of Kienbock’s disease in a seventeen year old female, student by profession, with history of trauma and painful wrist movements. Wrist arthroscopy, newest therapeutic modality was performed and multiple drilling of lunate was done.
Keywords: lunatomalacia, Osteosclerosis, Avascular necrosis, Kienbock’s disease.
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