title: Treatments for Kienböck disease: what the radiologist needs to know.
abstract: The etiology of Kienböck disease, or avascular necrosis of the lunate, is controversial, and there are a myriad of treatments aimed at correcting the various hypothesized pathologies. Interventions to reduce mechanical stress on the lunate have been used for decades, including radial osteotomy with or without radial shortening, ulnar lengthening and metaphyseal core decompression procedures. However, these procedures require preservation of lunate architecture. Newer procedures to revascularize the lunate bone have emerged in the last 10 years, such as pedicled corticoperiosteal vascularized bone grafting. Once there is collapse of the radiocarpal joint or midcarpal arthrosis, the conventional treatments have included proximal row carpectomy and complete or partial wrist joint arthrodesis. Newer salvage procedures such as lunate excision with autologous or synthetic interposition grafts are now being used when possible. As this disease is relatively rare, radiologists may not be familiar with the expected post-operative radiologic findings and complications, especially of the newer treatments. The goals of this paper are to review the available treatment options and their expected appearance on postoperative imaging, with discussion of possible complications when appropriate.
authors.affiliation: Department of Radiology, University of California, Los Angeles, 757 Westwood Blvd. Suite 1638, Los Angeles, CA, 90095, USA. carissawhite@mednet.ucla.edu.
authors.forename: Carissa
authors.identifier: http://orcid.org/0000-0001-6854-9874
authors.initials: C
authors.lastname: White
authors.affiliation: Department of Orthopaedic Surgery, University of California, Los Angeles, 10945 Le Conte Ave, Room 33-55 PVUB, Box 957326, Los Angeles, CA, 90095, USA.
authors.forename: Prosper
authors.initials: P
authors.lastname: Benhaim
authors.affiliation: Department of Radiology, University of California, Los Angeles, 1250 Sixteenth Street, Box 957036, Santa Monica, CA, 90404, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Plotkin
mesh_terms: D006801:Humans; D012667:Lunate Bone / Q000473:pathology*; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D010166:Palliative Care
keywords: Avascular necrosis; Kienböck; Lunate; Wrist