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Osteonecrosis of Wrist
Brady K. Huang, MD; Stephanie A. Bernard, MD; Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Ischemic necrosis, aseptic necrosis, avascular necrosis (AVN)
          • Definitions

            • Preiser disease: idiopathic scaphoid osteonecrosis (ON)
            • Kienböck disease: ON of lunate a.k.a. lunatomalacia

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • MR Findings

                  • CT Findings

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        Selected References

                                        1. Quintero JI et al: Avascular necrosis of the lunate secondary to perilunate fracture dislocation: case report and review of the literature. SAGE Open Med Case Rep. 9:2050313X211032398, 2021
                                        2. Rioux-Forker D et al: Osteonecrosis of the lunate: Kienböck disease. J Am Acad Orthop Surg. 28(14):570-84, 2020
                                        3. Nealey EM et al: Radiologic guide to surgical treatment of Kienbock's disease. Curr Probl Diagn Radiol. 47(2):103-9, 2018
                                        4. Kadar A et al: The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg Am. 42(2):78-86, 2017
                                        5. Lichtman DM et al: Kienböck disease: a new algorithm for the 21st century. J Wrist Surg. 6(1):2-10, 2017
                                        6. Bervian MR et al: Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery: diagnosis of scaphoid pseudarthrosis. Int Orthop. 39(1):67-72, 2015
                                        7. Larribe M et al: Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture. Skeletal Radiol. 43(12):1697-703, 2014
                                        8. Murphey MD et al: From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. 34(4):1003-28, 2014
                                        9. Derby BM et al: Vascularized bone grafts for the treatment of carpal bone pathology. Hand (N Y). 8(1):27-40, 2013
                                        10. Murthy NS: The role of magnetic resonance imaging in scaphoid fractures. J Hand Surg Am. 38(10):2047-54, 2013
                                        11. Taljanovic MS et al: Imaging and treatment of scaphoid fractures and their complications. Semin Musculoskelet Radiol. 16(2):159-73, 2012
                                        12. Donati OF et al: Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion? Radiology. 260(3):808-16, 2011
                                        13. Schmitt R et al: Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI? Eur J Radiol. 77(2):222-7, 2011
                                        14. Fox MG et al: Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol. 195(4):W281-6, 2010
                                        15. Lichtman DM et al: The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 35(7):549-54, 2010
                                        16. Oehmke MJ et al: The blood supply of the scaphoid bone. J Hand Surg Eur Vol. 34(3):351-7, 2009
                                        17. Schuind F et al: Kienbock's disease. J Bone Joint Surg Br. 90(2):133-9, 2008
                                        18. Zanetti M et al: Role of MR imaging in chronic wrist pain. Eur Radiol. 17(4):927-38, 2007
                                        19. Zafra M et al: Vascularised bone graft and osteotomy of the radius in Kienbock's disease. Acta Orthop Belg. 71(2):163-8, 2005
                                        20. Botte MJ et al: Vascularity and osteonecrosis of the wrist. Orthop Clin North Am. 35(3):405-21, xi, 2004
                                        21. Thienpont E et al: Radiographic analysis of anatomical risk factors for Kienbock's disease. Acta Orthop Belg. 70(5):406-9, 2004
                                        22. Murakami H et al: Revascularization of avascular necrosis of the capitate bone. AJR Am J Roentgenol. 179(3):664-6, 2002
                                        23. Allan CH et al: Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg. 9(2):128-36, 2001
                                        24. Gelberman RH et al: The vascularity of the scaphoid bone. J Hand Surg Am. 5(5):508-13, 1980
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Ischemic necrosis, aseptic necrosis, avascular necrosis (AVN)
                                                • Definitions

                                                  • Preiser disease: idiopathic scaphoid osteonecrosis (ON)
                                                  • Kienböck disease: ON of lunate a.k.a. lunatomalacia

                                                IMAGING

                                                • General Features

                                                  • Imaging Recommendations

                                                    • Radiographic Findings

                                                      • MR Findings

                                                        • CT Findings

                                                          • Nuclear Medicine Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              Selected References

                                                                              1. Quintero JI et al: Avascular necrosis of the lunate secondary to perilunate fracture dislocation: case report and review of the literature. SAGE Open Med Case Rep. 9:2050313X211032398, 2021
                                                                              2. Rioux-Forker D et al: Osteonecrosis of the lunate: Kienböck disease. J Am Acad Orthop Surg. 28(14):570-84, 2020
                                                                              3. Nealey EM et al: Radiologic guide to surgical treatment of Kienbock's disease. Curr Probl Diagn Radiol. 47(2):103-9, 2018
                                                                              4. Kadar A et al: The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg Am. 42(2):78-86, 2017
                                                                              5. Lichtman DM et al: Kienböck disease: a new algorithm for the 21st century. J Wrist Surg. 6(1):2-10, 2017
                                                                              6. Bervian MR et al: Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery: diagnosis of scaphoid pseudarthrosis. Int Orthop. 39(1):67-72, 2015
                                                                              7. Larribe M et al: Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture. Skeletal Radiol. 43(12):1697-703, 2014
                                                                              8. Murphey MD et al: From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. 34(4):1003-28, 2014
                                                                              9. Derby BM et al: Vascularized bone grafts for the treatment of carpal bone pathology. Hand (N Y). 8(1):27-40, 2013
                                                                              10. Murthy NS: The role of magnetic resonance imaging in scaphoid fractures. J Hand Surg Am. 38(10):2047-54, 2013
                                                                              11. Taljanovic MS et al: Imaging and treatment of scaphoid fractures and their complications. Semin Musculoskelet Radiol. 16(2):159-73, 2012
                                                                              12. Donati OF et al: Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion? Radiology. 260(3):808-16, 2011
                                                                              13. Schmitt R et al: Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI? Eur J Radiol. 77(2):222-7, 2011
                                                                              14. Fox MG et al: Assessment of scaphoid viability with MRI: a reassessment of findings on unenhanced MR images. AJR Am J Roentgenol. 195(4):W281-6, 2010
                                                                              15. Lichtman DM et al: The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 35(7):549-54, 2010
                                                                              16. Oehmke MJ et al: The blood supply of the scaphoid bone. J Hand Surg Eur Vol. 34(3):351-7, 2009
                                                                              17. Schuind F et al: Kienbock's disease. J Bone Joint Surg Br. 90(2):133-9, 2008
                                                                              18. Zanetti M et al: Role of MR imaging in chronic wrist pain. Eur Radiol. 17(4):927-38, 2007
                                                                              19. Zafra M et al: Vascularised bone graft and osteotomy of the radius in Kienbock's disease. Acta Orthop Belg. 71(2):163-8, 2005
                                                                              20. Botte MJ et al: Vascularity and osteonecrosis of the wrist. Orthop Clin North Am. 35(3):405-21, xi, 2004
                                                                              21. Thienpont E et al: Radiographic analysis of anatomical risk factors for Kienbock's disease. Acta Orthop Belg. 70(5):406-9, 2004
                                                                              22. Murakami H et al: Revascularization of avascular necrosis of the capitate bone. AJR Am J Roentgenol. 179(3):664-6, 2002
                                                                              23. Allan CH et al: Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg. 9(2):128-36, 2001
                                                                              24. Gelberman RH et al: The vascularity of the scaphoid bone. J Hand Surg Am. 5(5):508-13, 1980