logging in or signing up KIENBOCK DISEASE drmbhama Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1123 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 12, 2009 This Presentation is Public Favorites: 0 Presentation Description Avascular Necrosis of Lunate It is a painful disorder of wrist, due to avascular necrosis of carpal lunate, due to unknown cause. Comments Posting comment... By: dr_elmogy (13 month(s) ago) nbvc Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript KIENBOCK DISEASE : KIENBOCK DISEASE DR. MANOJ BHAMA SENIOR RESIDENT, DEPT. OF ORTHOPAEDICS, S.P. MEDICAL COLLEGE, BIKANER, INDIA mbhama@gmail.com KIENBOCK DISEASE : KIENBOCK DISEASE Synonyms: Avascular Necrosis of Lunate First Described by Robert Kienbock in 1910; as “traumatic softening” of Lunate bone It is a painful disorder of wrist, due to avascular necrosis of carpal lunate, due to unknown cause AETIOLOGY : AETIOLOGY Aetiology = unknown, but several cause have been proposed vascular compromise from repetitive trauma causes microfracture & excessive stress on microscopic architecture (sports injury) Ulnar minus variant:- Individual having ulnar minus variance are at increased risk. Short Ulna increases shear force across the lunate Causes vascular insufficiency EPIDIMIOLOGY : EPIDIMIOLOGY Age= 15-40 (young individuals) Sex= Men Location= Unilateral, Dominant wrist PATHOLOGY : PATHOLOGY Pathological changes proceed in 4 stages:- Stage 1: Ischemia with naked eye or radiological examination Stage 2: Trabeculae Necrosis with reactive new bone formation & increased radiographic density, but little or no distortion of shape. Stage 3: Collapse of Bone Stage 4: Disruption of Radio-carpal congruence & secondary OA PATHOLOGY : PATHOLOGY The natural history of Kienbock’s disease is Progressive Sclerosis Fragmentation Arthrosis CLINICAL FEATURE : CLINICAL FEATURE There may be history of trauma with wrist in severe dorsiflexion The lesion presents with 1. Dorsal wrist pain:- Pain may be produced in lunate region by axial strike/injury at distal end of middle finger 2. Swelling 3. Decreased Grip strength 4. Decreased range of motion; particularly in extension. In later stage movement may be painful IMAGING : IMAGING X-ray at first show no abnormality but bone scan may reveals increased activity Later x-ray may show either mottled or diffuse density of bone – to – osteoarthritic changes in wrist MRI Most reliable way of detecting the early change CLASSIFICATION : CLASSIFICATION Kienbock disease advances through 4 radiological stages Stage I : Normal architecture; consistent with Microfracture (Lunate abnormal on bone scan) Stage II : Lunate sclerosis without collapse Stage III : Lunate collapse or Fragmentation & proximal migration of capitate Stage IV : Perilunate arthritis changes TREATMENT : TREATMENT A Conservative Casting of wrist for several wks ; for early stages of disease ( St I or II, before sclerosis, fragmentation or collapse) But- Unacceptable & Ineffective B Operative Surgery is only definitive treatment Early Disease Stage I & II : Early Disease Stage I & II Unloading the Lunate* 1. Ulnar lengthening Transverse osteotomy at distal ulna Distraction Cortical iliac graft Tightening of plate screw Early Disease Stage I & II : Early Disease Stage I & II 2. Radial Shortening Indication Negative ulnar variance Lunate compression fracture without fragmentation or flattening Procedure Transverse osteotomy 3” proximal to distal articulating surface shortening of radius by 2 cm fixing the bone with compression plate In stage III : In stage III 1. Ulnar lengthening 2. Silicon prosthesis - silicon synovitis - foreign body cyst 3. Interacarpal fusion 4. Lunate excision 5. Arthrodesis Tri scaphe Scaphocapitate In stage IV : In stage IV Proximal carpal row resection Wrist arthrodesis You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
KIENBOCK DISEASE drmbhama Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1123 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 12, 2009 This Presentation is Public Favorites: 0 Presentation Description Avascular Necrosis of Lunate It is a painful disorder of wrist, due to avascular necrosis of carpal lunate, due to unknown cause. Comments Posting comment... By: dr_elmogy (13 month(s) ago) nbvc Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript KIENBOCK DISEASE : KIENBOCK DISEASE DR. MANOJ BHAMA SENIOR RESIDENT, DEPT. OF ORTHOPAEDICS, S.P. MEDICAL COLLEGE, BIKANER, INDIA mbhama@gmail.com KIENBOCK DISEASE : KIENBOCK DISEASE Synonyms: Avascular Necrosis of Lunate First Described by Robert Kienbock in 1910; as “traumatic softening” of Lunate bone It is a painful disorder of wrist, due to avascular necrosis of carpal lunate, due to unknown cause AETIOLOGY : AETIOLOGY Aetiology = unknown, but several cause have been proposed vascular compromise from repetitive trauma causes microfracture & excessive stress on microscopic architecture (sports injury) Ulnar minus variant:- Individual having ulnar minus variance are at increased risk. Short Ulna increases shear force across the lunate Causes vascular insufficiency EPIDIMIOLOGY : EPIDIMIOLOGY Age= 15-40 (young individuals) Sex= Men Location= Unilateral, Dominant wrist PATHOLOGY : PATHOLOGY Pathological changes proceed in 4 stages:- Stage 1: Ischemia with naked eye or radiological examination Stage 2: Trabeculae Necrosis with reactive new bone formation & increased radiographic density, but little or no distortion of shape. Stage 3: Collapse of Bone Stage 4: Disruption of Radio-carpal congruence & secondary OA PATHOLOGY : PATHOLOGY The natural history of Kienbock’s disease is Progressive Sclerosis Fragmentation Arthrosis CLINICAL FEATURE : CLINICAL FEATURE There may be history of trauma with wrist in severe dorsiflexion The lesion presents with 1. Dorsal wrist pain:- Pain may be produced in lunate region by axial strike/injury at distal end of middle finger 2. Swelling 3. Decreased Grip strength 4. Decreased range of motion; particularly in extension. In later stage movement may be painful IMAGING : IMAGING X-ray at first show no abnormality but bone scan may reveals increased activity Later x-ray may show either mottled or diffuse density of bone – to – osteoarthritic changes in wrist MRI Most reliable way of detecting the early change CLASSIFICATION : CLASSIFICATION Kienbock disease advances through 4 radiological stages Stage I : Normal architecture; consistent with Microfracture (Lunate abnormal on bone scan) Stage II : Lunate sclerosis without collapse Stage III : Lunate collapse or Fragmentation & proximal migration of capitate Stage IV : Perilunate arthritis changes TREATMENT : TREATMENT A Conservative Casting of wrist for several wks ; for early stages of disease ( St I or II, before sclerosis, fragmentation or collapse) But- Unacceptable & Ineffective B Operative Surgery is only definitive treatment Early Disease Stage I & II : Early Disease Stage I & II Unloading the Lunate* 1. Ulnar lengthening Transverse osteotomy at distal ulna Distraction Cortical iliac graft Tightening of plate screw Early Disease Stage I & II : Early Disease Stage I & II 2. Radial Shortening Indication Negative ulnar variance Lunate compression fracture without fragmentation or flattening Procedure Transverse osteotomy 3” proximal to distal articulating surface shortening of radius by 2 cm fixing the bone with compression plate In stage III : In stage III 1. Ulnar lengthening 2. Silicon prosthesis - silicon synovitis - foreign body cyst 3. Interacarpal fusion 4. Lunate excision 5. Arthrodesis Tri scaphe Scaphocapitate In stage IV : In stage IV Proximal carpal row resection Wrist arthrodesis