[Kienböck's disease. Current data].

Abstract

Aseptic osteonecrosis of the lunate bone is a rare disease of unknown aetiology. The mechanical theory of shearing of the lunate underneath the radius is generally accepted, especially in the presence of a short ulna, even if it is insufficient. The diagnosis is exclusively radiographic and requires, in the early stages, the use of MRI which is more sensitive and specific than bone scan. Plain X-rays allow the disease to be classified into various stages, which determine the therapeutic indications. Many treatments have been proposed, but the follow-up is often inadequate. Simple immobilization is atraumatic, but its efficacy is highly controversial. Equalization of the two bones, usually by shortening the radius, is the most widely used technique and, with a follow-up of more than 20 years, appears to be effective in 80% of subjects. Revascularization of the lunate has been proposed in the early forms. Partial arthrodeses are indicated in the advanced forms. Radio-carpal arthrodesis or denervation of the wrist are indicated in the presence of osteoarthritis. Functional sequelae are frequent in these young subjects, who are often manual workers.