Kienbock‘s Disease

English

مرض كينبوك

SUMMARY

Described by Keinbock in 1910, a radiologist in Vienna. = collapse of the lunate bone due to disruption of blood supply to the bone

Aetiology:

Uncertain

Treatment:

Kienbock01 Kienbock02

 

Remember:

  • Casting for up to 4 months and analgesia could help with the pain but it doesn’t treat the disease
  • No surgical procedure has been conclusively and definitely shown to prevent progression.

 

Surgery:

Stage 1 & 2:

Aim:

To prevent bone collapse

Procedure of Choice

Vascularized bone graft +/- shortening of the long bone of the forearm

 

All these procedures have a 70% success rate in pain relief

Kienbock03 Kienbock04

Kienbock05

After treatment

A splint is applied

The drain is removed after 1 or 2 days.

Finger motion and wrist motion are encouraged.

The splint is removed to allow inspection of the wound, and the sutures are removed at 10-14 days.

A solid forearm cast is applied extending above the elbow, or a solid sugar-tong splint is used for 4 weeks. The cast is removed to evaluate the osteotomy with radiographs

Cast immobilization re applied for another 4 weeks and X rays done

Exercise and light use of the hand are encouraged throughout convalescence.