8/13/2019 12.11.2 Wrist - Kienbocks & Ulnar Variance

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12.11.2 WRIST - KIENBCKS DISEASE AND ULNAR VARIANCE

= Lunatomalacia 11! "# $%&t% 1'()*

=AVASCULAR NECROSIS OF THE MAJOR SEGMENT (DORSAL POLE) OF THELUNATE

$+%&%ntation Painful stiff s!ll"n #ist

$!un% a&ti'" ault

MF *+

Unilat"#al D!,inant

Ma- ." u" t! a st#"ss f#a&tu#" t/at l"as t! "'as&ula#i0ati!n !f t/",a1!# s"%,"nt !f t/" lunat" if t/" lunat" is su22li" .- !n" '!la# '"ss"l

Ass!& ulna# ,inus 'a#ian&" %"t ,!#" s/"a# !n '!la# .l!! su22l-

3*4 n!#,al an 564 7i"n.!&89s /a'" ulna# n"%ati'" 'a#ian&"

Dia,no&i& :;#a- (lat") CT

MRI

I Rai!lu&"nt Lin" = &!,2#"ssi!n B

II D",in"#alisati!n a#!un B (*+3)

IIIa S&l"#!sis !f !#sal 2!l" &a#2al /"i%/t n!#,al

III. F#a%,"ntati!n an flatt"nin% &a#2al /"i%/t #"u&"

IV #ist a#t/#!sis? f#a%,"nt" lunat" an 2#!i,al ,i%#ati!n !f t/"&a2itat"

T+%atm%nt tion& Clinical &ta,% 3 R4 "Lic5tman* I >'" .!n" s&an n!#,al ;#a- = i,,!.ilis"

II s&l"#!ti& ;#a- = #aial s/!#t"nin% t! %"t n"ut#al 'a#ian&"

III lunat" &!lla2s" ;#a- = s/!#t #aius > #"s"&t lunat" t"n!nint"#2!siti!n

IV &a#2al a#t/#itis = 2#!i,al #! &a#2"&t!,- !# #ist fusi!n

%+ation& Sta%" + ; F!u&/"#? +66? sa-s t#- &!ns"#'ati'" ,ana%","nt fi#st ala-s

Sta%" 3*ao Eualisati!n ; Raial s/!#t"nin% ("asi"# t/an ulna# l"n%t/"nin%)? !

n!t int"#f"#" it/ ROM !# "&!,2#"ssi!n !# &a#2al sta.ilisati!no F!u# C!#n"# fusi!n? T#is&a2/" (STT) fusi!n? Lunat" #"'as&ula#isati!n

('as&ula#is" 2isif!#,#aius'as&ula# .unl" @ !#sal MC a#t"#-it/ !# it/!ut .!n" %#aft)

Sta%" *.o E&isi!n A#t/#!2last- @ si,2l" lunat" "&isi!nan&/!'- (&!il"

t"n!n)STT fusi!n G#an"# !2"#ati!n (SLC fusi!n)

Sta%" o P#!i,al R! &a#2"&t!,-o #ist fusi!n

Last 2#int" 33 +*** a2 ; + @'a#a22s&!n'"#si!nt,2sat&/K+*+5!&

8/13/2019 12.11.2 Wrist - Kienbocks & Ulnar Variance

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Natu+al 5i&to+6 M!st ill %"t !#s" ;#a-s? .ut n!t n"&"ssa#il- !#s" s-,2t!,s

If /a .a s-,2t!,s t! sta#t it/ !n9t %"t ."tt"# it/ n!n !2"#ati'"t#"at,"nt

ULNAR VARIANCE "ULTEN7S 3a+ianc% *

H!#i0!ntal lin" #an f#!, t/" 1un&ti!n !f t/" istal a#ti&ula# su#fa&" ansi%,!i n!t&/ !f t/" #aius (t/" &u#'" t/at a#ti&ulat"s it/ t/" ulna)

>'" 'a#ian&" = ulna# /"a a.!'" t/is lin" ulna# i,2in%","nt s-n#!,"

;'" 'a#ian&" = ulna# /"a a.!'" t/is lin" 7i"n.!&89s is"as"? SLisl!&ati!n

N"ut#al = n!#,al ulna# /"a l"'"l

Ulna 0"#! = sa," l"n%t/

Ulna 2lus ulna +; ,, l!n%"#

Ulna ,inus ulna + t! ,, s/!#t"#

In"2"n"nt !f t/" st-l!i l"n%t/

M"asu#","nt aff"&t" .- f!#"a#, #!tati!n? #ist 2!siti!n? %#i2 l!ain%

Last 2#int" 33 +*** a2 ; 3 @'a#a22s&!n'"#si!nt,2sat&/K+*+5!&