Abstract

SIMOES, Ricardo et al. Doença de Kienböck. Rev. Port. Ortop. Traum. [online]. 2016, vol.24, n.2, pp.112-120. ISSN 1646-2122.

The authors conducted a literature review of the Kienböck disease with regard to its definition, epidemiology, pathophysiology, diagnosis, treatment and prognosis. An article survey was conducted in PubMed, Medline and Cochrane Review, which dealt with the disease, published between the years 1994 and 2015. Also book chapters and websites were used. The Kienböck disease is defined by avascular necrosis of the lunate and affects preferably individuals between 20 and 40 years old male. The pathophysiology is multifactorial. The diagnosis is based on clinical history, physical examination and supplementary diagnostic tests. Clinically, patients present with pain and decreased muscle strength, progressing to carpal instability and degenerative arthritis. Radiography is a key diagnostic test, computed tomography is useful in advanced stages and the MRI is particularly important in the early stages. The most accepted classification is the Lichtman et al. Regarding treatment, the conservative approach is the first line, and the need for surgical intervention is dictated by the patient's symptoms. Several surgical procedures have been used, depending on the stage presented, but the surgical approach has not yet demonstrated, definitely, change the natural history of the disease. Age is the most important prognostic factor, which is worse in patients aged over 30 years. The Kienböck disease keeps a challenging problem and the understanding of its pathophysiology, natural history and treatment depend on multicenter studies in order to provide consistent and targeted outcomes for patients.

Keywords : Kienböck disease; lunate; Lichtman; carpal.

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