Non-operative

Non-operative management is aimed at alleviating pain. 4-dimensional CT of patients with Keinbocks disease shows how the collapsed lunate causes abnormal stress on other load bearing parts. Rest, anti-inflammatories and temporary splinting helps, but the abnormal articulation will persist. It is a tricky condition to manage, and in some cases alternative work that does not load the wrist needs to be sought.

Operative

Operative management is aimed at either unloading the lunate if still intact, or excising the lunate if it is not salvageable and performing limited fusions within the wrist. This rebalances the load of the wrist through other normal cartilage articulations. Unloading the lunate means reducing the load on the lunate in order to increase the blood supply and prevent further death of the lunate. This may take the form of an ulnar, radial, or capitate shortening osteotomy, depending on which is more appropriate in each patient.

Pyrocarbon is an exciting new composite from which implants are now being manufactured due to its incredible durability and high biocompatibility. In certain cases a pyrocarbon lunate replacement may be appropriate and will be discussed.