Keinbocks Disease


This is a unique disease of the lunate bone, a central bone in the base of the wrist, where it’s blood supply decreases to a point where the bone dies, collapses and may fracture. It most commonly occurs in men around the age of 20-45. The cause of the disease is unknown but differing blood supply patterns have been thought to be partly causal. Patients usually experience some pain, swelling and stiffness in the wrist, and this may persist for some months prior to presenting to a specialist.

Early stages of the disease are often missed as they are not visible on Xray, and only MRI will show the diagnosis. Once the diagnosis is made, management depends on the age and activity level of the patient, and is directed at the specific stage of the disease. 



  • Management
Management

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.


Conditions Managed



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