The effect of lunate morphology in kienböck disease

Peter C. Rhee, David B. Jones, Steven Lawrence Moran, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose To determine if the absence (type I lunate) or presence (type II lunate) of a medial hamate facet on the lunate affects the radiographic characteristics of patients presenting with Kienböck disease. Methods A retrospective review was performed on all patients evaluated at our institution from 2002 to 2010 with a diagnosis of Kienböck disease confirmed on plain radiographs in concert with magnetic resonance imaging (MRI) and/or bone scan. Study groups consisted of patients with type I versus type II lunates, as determined by radiographs, MRI, and/or computed tomography. Measured variables included the modified Lichtman stage on presentation, radioscaphoid angle, presence or absence of a coronal plane fracture of the lunate, modified carpal height, ulnar variance, and ulnar translocation of the carpus at the time of presentation. Results A total of 106 wrists were examined, of which 75 were type I (71%) and 31 were type II (29%) lunates. At the time of presentation, there was significantly more advanced disease (stage IIIA or greater) in patients with type I (N = 64, 86%) compared with those with type II lunates (N = 19, 61%). Coronal fractures of the lunate were more prevalent in patients with type I (N = 58, 75%) compared with type II lunates (N = 18, 58%). In the absence of a coronal fracture, radioscaphoid angles were greater in patients with a type I (53°) versus a type II lunate (45°). Conclusions Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. Type II lunates appear to be protective against coronal fractures and scaphoid flexion deformities. This study provides further evidence that lunate morphology affects carpal pathology and may have implications for treatment options in Kienböck disease. Type of study/level of evidence Prognostic III.

Original languageEnglish (US)
Pages (from-to)738-744
Number of pages7
JournalJournal of Hand Surgery
Volume40
Issue number4
DOIs
StatePublished - Apr 1 2015

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Wrist
Magnetic Resonance Imaging
Tomography
Pathology
Bone and Bones
Therapeutics

Keywords

  • Kienbock disease
  • lunate coronal plane fracture
  • lunate morphology
  • radioscaphoid angle
  • scaphoid fiexion deformity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

The effect of lunate morphology in kienböck disease. / Rhee, Peter C.; Jones, David B.; Moran, Steven Lawrence; Shin, Alexander Yong-Shik.

In: Journal of Hand Surgery, Vol. 40, No. 4, 01.04.2015, p. 738-744.

Research output: Contribution to journalArticle

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title = "The effect of lunate morphology in kienb{\"o}ck disease",
abstract = "Purpose To determine if the absence (type I lunate) or presence (type II lunate) of a medial hamate facet on the lunate affects the radiographic characteristics of patients presenting with Kienb{\"o}ck disease. Methods A retrospective review was performed on all patients evaluated at our institution from 2002 to 2010 with a diagnosis of Kienb{\"o}ck disease confirmed on plain radiographs in concert with magnetic resonance imaging (MRI) and/or bone scan. Study groups consisted of patients with type I versus type II lunates, as determined by radiographs, MRI, and/or computed tomography. Measured variables included the modified Lichtman stage on presentation, radioscaphoid angle, presence or absence of a coronal plane fracture of the lunate, modified carpal height, ulnar variance, and ulnar translocation of the carpus at the time of presentation. Results A total of 106 wrists were examined, of which 75 were type I (71{\%}) and 31 were type II (29{\%}) lunates. At the time of presentation, there was significantly more advanced disease (stage IIIA or greater) in patients with type I (N = 64, 86{\%}) compared with those with type II lunates (N = 19, 61{\%}). Coronal fractures of the lunate were more prevalent in patients with type I (N = 58, 75{\%}) compared with type II lunates (N = 18, 58{\%}). In the absence of a coronal fracture, radioscaphoid angles were greater in patients with a type I (53°) versus a type II lunate (45°). Conclusions Lunate morphology may affect the severity of Kienb{\"o}ck disease at the time of initial presentation. Type II lunates appear to be protective against coronal fractures and scaphoid flexion deformities. This study provides further evidence that lunate morphology affects carpal pathology and may have implications for treatment options in Kienb{\"o}ck disease. Type of study/level of evidence Prognostic III.",
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N2 - Purpose To determine if the absence (type I lunate) or presence (type II lunate) of a medial hamate facet on the lunate affects the radiographic characteristics of patients presenting with Kienböck disease. Methods A retrospective review was performed on all patients evaluated at our institution from 2002 to 2010 with a diagnosis of Kienböck disease confirmed on plain radiographs in concert with magnetic resonance imaging (MRI) and/or bone scan. Study groups consisted of patients with type I versus type II lunates, as determined by radiographs, MRI, and/or computed tomography. Measured variables included the modified Lichtman stage on presentation, radioscaphoid angle, presence or absence of a coronal plane fracture of the lunate, modified carpal height, ulnar variance, and ulnar translocation of the carpus at the time of presentation. Results A total of 106 wrists were examined, of which 75 were type I (71%) and 31 were type II (29%) lunates. At the time of presentation, there was significantly more advanced disease (stage IIIA or greater) in patients with type I (N = 64, 86%) compared with those with type II lunates (N = 19, 61%). Coronal fractures of the lunate were more prevalent in patients with type I (N = 58, 75%) compared with type II lunates (N = 18, 58%). In the absence of a coronal fracture, radioscaphoid angles were greater in patients with a type I (53°) versus a type II lunate (45°). Conclusions Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. Type II lunates appear to be protective against coronal fractures and scaphoid flexion deformities. This study provides further evidence that lunate morphology affects carpal pathology and may have implications for treatment options in Kienböck disease. Type of study/level of evidence Prognostic III.

AB - Purpose To determine if the absence (type I lunate) or presence (type II lunate) of a medial hamate facet on the lunate affects the radiographic characteristics of patients presenting with Kienböck disease. Methods A retrospective review was performed on all patients evaluated at our institution from 2002 to 2010 with a diagnosis of Kienböck disease confirmed on plain radiographs in concert with magnetic resonance imaging (MRI) and/or bone scan. Study groups consisted of patients with type I versus type II lunates, as determined by radiographs, MRI, and/or computed tomography. Measured variables included the modified Lichtman stage on presentation, radioscaphoid angle, presence or absence of a coronal plane fracture of the lunate, modified carpal height, ulnar variance, and ulnar translocation of the carpus at the time of presentation. Results A total of 106 wrists were examined, of which 75 were type I (71%) and 31 were type II (29%) lunates. At the time of presentation, there was significantly more advanced disease (stage IIIA or greater) in patients with type I (N = 64, 86%) compared with those with type II lunates (N = 19, 61%). Coronal fractures of the lunate were more prevalent in patients with type I (N = 58, 75%) compared with type II lunates (N = 18, 58%). In the absence of a coronal fracture, radioscaphoid angles were greater in patients with a type I (53°) versus a type II lunate (45°). Conclusions Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. Type II lunates appear to be protective against coronal fractures and scaphoid flexion deformities. This study provides further evidence that lunate morphology affects carpal pathology and may have implications for treatment options in Kienböck disease. Type of study/level of evidence Prognostic III.

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