SHAHRAM SHAHMARY Kienbocks disease

Information about SHAHRAM SHAHMARY Kienbocks disease

Published on January 9, 2009

Author: shahmary

Source: authorstream.com

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KIENBOCK’S DISEASE : KIENBOCK’S DISEASE Shahram Shahmary .MD Slide 2: ETIOLOGY CLASSIFICATION DIAGNOSIS TREATMENT OUTCOME KIENBOCK’S DISEASE : KIENBOCK’S DISEASE KIENBOCK’S DISEASE : KIENBOCK’S DISEASE BLOOD SUPPLY TRAUMA ULNA MINUS LUNATE SHAPE Blood Supply : Blood Supply Volar Aspect Dorsal aspect Intraosseous Circulation : Intraosseous Circulation Lunate Fracture : Lunate Fracture Ulnar Variance : Ulnar Variance Diagnosis : Diagnosis radiographic young adults pain , stiffness . tenderness marked loss of grip strength Diagnosis : Diagnosis early - Xrays normal MRI Bone Scan CT Diagnosis : Diagnosis AVN on MRI - low signal on T1 & T2 MRI helps to differentiate Kienbocks from other causes of radiolucency in lunate Bone scan : increased uptake MRI : MRI Classification:Lichtmann Staging : Classification:Lichtmann Staging Stage 1 Normal Xray,MRI/Bone scan+ve Stage 2 Abnormal density Stage 3a lunate collapse Stage 3b carpal collapse Stage 4 osteoarthritis Staging : Staging Carpal Angles : Carpal Angles Carpal Angles : Carpal Angles 47 degrees(30-60) 0 degrees(+/- 15) Carpal Height : Carpal Height L2/L1 = 0.54+/-0.03 REVISED CARPAL HEIGHT RATIO =L2/CAPITATE LENGTH = 1.57 +/- 0.05 Treatment : Treatment natural history unclear some studies suggest nonoperative treatment better others show arthritic changes 60 - 80 % of nonoperatively treated patients Xrays progress but symptoms may not Treatment : Surgical : Treatment : Surgical lunate resection & arthroplasty STT or capitate-hamate arthrodesis wrist levelling procedures-radial,ulnar Capitate shortening vascularised bone grafts +/- Ex-Fix Ex-Fix + cancellous graft Wedge Osteotomy : Wedge Osteotomy STT Fusion : STT Fusion STT Fusion Graft Site : STT Fusion Graft Site STT Fusion : STT Fusion Vascularised Bone Graft : Vascularised Bone Graft Salvage procedures : Salvage procedures Wrist arthrodesis Proximal row carpectomy Wrist arthroplasty - not Wrist Fusion : Wrist Fusion What I do : What I do treat conservatively after patient education Stage 1 - 3 & ulna minus : Radial shortening Stage 1 - 3 & ulna neutral : STT Stage 4 : arthrodesis Kienbock’s disease : Kienbock’s disease Outcome wrist-levelling Pain relief : 70-80 % Grip strength : 30-50% Xray : no improvement or deterioration ?ROM ?MRI THE END : THE END

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