This 2001 narrative review by Allan, Joshi, and Lichtman summarizes the etiology, imaging-based staging, and stage-specific surgical management of Kienbock's disease (lunate osteonecrosis), using the Lichtman classification as the organizing framework for treatment selection.
When a young patient presents with dorsal wrist pain and normal radiographs, order MRI to rule out stage I Kienbock's — missing it means missing the window for joint-preserving intervention.
Once you have a stage, check ulnar variance: it directly determines whether radial shortening or capitate-unloading procedures are appropriate for stages II and IIIA.
This 2001 narrative review by Allan, Joshi, and Lichtman summarizes the etiology, imaging-based staging, and stage-specific surgical management of Kienbock's disease (lunate osteonecrosis), using the Lichtman classification as the organizing framework for treatment selection.
When a young patient presents with dorsal wrist pain and normal radiographs, order MRI to rule out stage I Kienbock's — missing it means missing the window for joint-preserving intervention.
Once you have a stage, check ulnar variance: it directly determines whether radial shortening or capitate-unloading procedures are appropriate for stages II and IIIA.