Kienbock's Disease

Kienbock's disease, extended Lichtman classification

I Xrays normal except for possible lunate fracture
bone scan abnormal
II Changes in lunate density Tomograms:
    +/- may show lunate fracture
    +/- flattening
    +/- minimal radial side collapse
III Lunate collapse,
Normal scaphoid palmar flexion
IIIB Palmar flexion of the scaphoid
IV All stage III changes + generalized arthritis


Kienbock's Fracture Pattern
Transverse shear
Longitudinal biplanar
Comminuted collapse

Simplified staging scheme

Lunate bone
Lunate fracture in acute trauma
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