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The hand surgery landscape| Volume 45, ISSUE 2, P148-152, February 2020

Avascular Necrosis of the Carpal Bones Other Than Kienböck Disease

  • Ahmadreza Afshar
    Correspondence
    Corresponding author: Ahmadreza Afshar, MD, Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Modaress Street, Ershad Boulevard, Urmia 57157-81351, Iran.
    Affiliations
    Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
    Search for articles by this author
  • Ali Tabrizi
    Affiliations
    Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
    Search for articles by this author
Published:October 01, 2019DOI:https://doi.org/10.1016/j.jhsa.2019.05.022
      Avascular necrosis (AVN) of the carpal bones other than Kienböck disease is a rare cause of chronic pain of the wrist. The scaphoid, capitate, and a smaller percent of lunates are at greater risk to develop AVN because of their peculiar intraosseous circulation; however, AVN has been reported in all the carpal bones. On the plain radiograph, AVN of the carpal bones may evolve through a normal radiograph, sclerosis, fragmentation, cyst formation, fracture, bone collapse, change of the carpal height, and alignment and progressive degenerative changes of the wrist joint. In the early stage of AVN, magnetic resonance imaging enhanced with gadolinium is a more sensitive and specific diagnostic tool than plain radiograph to demonstrate the bone marrow viability. Because of the rarity of case reports, the natural history of AVN of the carpal bones other than Kienböck disease is not well understood. The aims of different treatments are to prevent bone collapse, restore normal carpal height and alignment, and reduce the risk of progressive degenerative changes of the wrist joint.

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