THE RESULTS OF TREATMENT IN KIENBÖCK'S DISEASE

Abstract

Kienb#{246}ck’s disease is not common but it occurs sufficiently often to be of orthopaedic importance. The treatment and the prognosis are particularly important because most of the cases occur in heavy workers. For this reason it is of interest to review the results of treatment in a series of patients from an industrial area. The condition was recognised by various observers before 1910, but it was KienbOck who first made a thorough study of the subject and tried to correlate the radiographic findings with the various clinical phases. He held that the condition was a malacia of the lunate bone from interference with the blood supply through the ligaments. This he attributed to injury which could be caused by a momentary subluxation of the bone (“ jump subluxation “). Such fractures as might occur he regarded as secondary. Persson (1945) agreed with the view originally advanced by Hult#{233}n (1928) that an important etiological factor is relative shortening of the lower end of the ulna with increased prominence of the articular surface of the radius, so that the lunate bone is exposed to greater stress in compression injuries of the wrist. This anatomical state, which Persson termed the “minus variation,” was found in 8 per cent. of the general population, but in as many as ten of his nineteen cases of KienbOck’s disease. This variation was present in a much smaller proportion of our cases. Persson advocated lengthening the ulna and reported good results. He believed that the operation relieved mechanical stress and so enabled the lunate bone to regenerate. The condition has also been considered due to primary fractures, aseptic emboli and osteitis, but is now generally ascribed to avascular necrosis from traumatic interference with the blood supply.