Kienbock, Preiser-Overview

Overview — Osteonecrosis
Pdf Summary
Avascular necrosis (AVN) is a condition characterized by cellular death of bone components as a result of interruption of blood supply. This leads to bone collapse, joint destruction, pain, and loss of joint function. AVN commonly affects the epiphysis of long bones such as the femoral head, humeral head, and femoral condyles, but can also affect small wrist bones like the lunate, scaphoid, and capitate. The etiology of AVN in the hand and wrist is often unknown, though several risk factors have been identified including corticosteroid use, collagen vascular disorders, alcoholism, sickle cell disease, and gout. The pathogenesis of osteonecrosis typically consists of four phases: avascular phase, revascularization phase, repair phase, and deformity phase. Each phase is associated with histological and radiographic changes. AVN in the hand and wrist most commonly affects the scaphoid, lunate, and capitate. Preiser disease is AVN of the scaphoid occurring without trauma or prior wrist procedures. It is associated with pain in the snuffbox area and radiographic changes in the scaphoid. Kienböck disease is AVN of the lunate, most commonly observed in patients aged 20-40 years. Ulnar variance and lunate morphology have been associated with the development of Kienböck disease. Diagnosis is typically made through x-rays, MRI, or bone scintigraphy. Treatment options for Preiser and Kienböck diseases include observation, silicone replacement, arthroscopic debridement, and various surgical procedures. AVN of the capitate, metacarpal head, and phalanges are less common and may occur due to trauma, systemic diseases, or independently. Treatment options for these conditions vary and may include observation, decompression, bone grafting, fusion, or arthroplasty.
Keywords
Avascular necrosis
AVN
bone collapse
joint destruction
pain
risk factors
Preiser disease
Kienböck disease
diagnosis
treatment options