Kienböck Disease: Avascular necrosis (osteonecrosis) of the lunate leading to abnormal carpal motion
1910 – Kienböck published his article on traumatic malacia of the lunate, providing the earliest description of avascular necrosis of the lunate. He presented 16 of his own cases and presented his views on pathogenesis and treatment. He described isolated disease of the lunate associated with only slight secondary changes in other carpal bones. Clinical examination revealed limited active wrist motion and pain on passive movement.
Kienböck believed that the cause of the disease was a disturbance in the nutrition of the lunate caused by the rupture of ligaments and blood vessels during contusions, sprains, or subluxations. He proposed that fractures seen on X-Ray occurred after the lunate had been weakened by ligament and blood vessel rupture.
1925 – Goldsmith reported the first cases of Kienböck disease in the American literature as fractures of the lunate in the absence of a history of trauma.
- Robert Kienböck (1871-1953)
- Kienböck syndrome
Multiple sources cite JL Peste with the original description of lunate osteonecrosis. However closer inspection of the 200 word Society minutes is warranted.
Peste presented the clinical case of an individual suffering major trauma following a four story fall and the resultant autopsy findings. These included a comminuted compound skull and face fractures; wrist dislocation and a ‘double-fracture‘ of the lunate.
Very likely an early description of lunate fracture, but not the first description of Kienböck disease.
Peste 1843 – la semi-lunaire, était le siege aussi d’une double fracture
- Kienböck R. Über traumatische Malazie des Mondbeins und ihre Folgezustände: Entartungsformen und Kompressionfrakturen. Fortschritte auf dem Gebiete der Röntgenstrahlen. 1910–1911;16:77– 103. [Peltier LF. Translation: Concerning traumatic malacia of the lunate and its consequences: degeneration and compression fractures. Clin Orthop Relat Res. 1980 Jun;(149):4-8. PMID6996884]
- Goldsmith R. Kienböck’s disease of the semilunar bone. Ann Surg 1925;81:857– 862.
- Peste JL. Extrait des procès-verbaux des séances de la société. Bulletin de la Société Anatomique de Paris. August 1843;18:169 –170.
- Gerwin M. The history of Kienböck’s disease. Hand Clin. 1993 Aug;9(3):385-90. [PMID 8408248]