Association of the Interfacet Angle and the Lunate Facet Inclination Angle With Kienböck Disease

Published:September 07, 2021DOI:


      The etiology of Kienböck disease remains unclear, although mechanical, vascular, and metabolic risk factors have been suggested. We aimed to investigate the association of the angle between the curvatures of the distal radius and the development of Kienböck disease.


      The lunate facet inclination (LFI), scaphoid facet inclination, and interfacet angle (IFA) values were measured using posteroanterior plain radiographs of 82 patients diagnosed with Kienböck disease. The results were compared with normative angular reference values published based on an analysis of 400 wrists of Caucasian patients aged between 20 and 45 years. The posteroanterior radiographs were divided into 3 categories: negative, neutral, and positive based on ulnar variance, and the relationship between ulnar variance and facet angles was evaluated.


      The IFA value was significantly higher than the normative angular reference value in the patients with Kienböck disease. Conversely, the LFI values were significantly lower in the Kienböck patient group. There were no statistically significant differences in the IFA and LFI values among the ulnar variance groups.


      Measuring IFA and LFI allows the evaluation of the bifacet curvature of the distal radius articular surface in the coronal plane. Steep IFA and shallow LFI are associated with Kienböck disease. Increased IFA may lead to abnormal load transmission to the intermediate column, which might eventually lead to increased stress on the lunate.

      Type of study/level of evidence

      Prognostic IV.

      Key words

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        • Kienböck R.
        Concerning traumatic malacia of the lunate and its consequences [in German].
        Fortschr Röntgenstr. 1910; 16: 77-103
        • Lluch A.
        • Garcia-Elias M.
        Etiology of Kienbock disease.
        Tech Hand Up Extrem Surg. 2011; 15: 33-37
        • Watson H.K.
        • Guidera P.M.
        Aetiology of Kienböck’s disease.
        J Hand Surg Br. 1997; 22: 5-7
        • Afshar A.
        • Aminzadeh-Gohari A.
        • Yekta Z.
        The association of Kienbock’s disease and ulnar variance in the Iranian population.
        J Hand Surg Eur. 2013; 38: 496-499
        • Mirabello S.C.
        • Rosenthal D.I.
        • Smith R.J.
        Correlation of clinical and radiographic findings in Kienböck’s disease.
        J Hand Surg Am. 1987; 12: 1049-1054
        • Kwak S.H.
        • Lee K.H.
        • Kang S.B.
        • Lee H.J.
        • Baek G.H.
        Radiological characteristics of Kienböck’s disease in the Korean population.
        J Orthop Surg. 2017; 252309499016684436
        • Thienpont E.
        • Mulier T.
        • Rega F.
        • De Smet L.
        Radiographic analysis of anatomical risk factors for Kienböck’s disease.
        Acta Orthop Belg. 2004; 70: 406-409
        • Arik A.
        • Bas C.E.
        • Tanrikulu S.
        • Sanverdi E.
        • Leblebicioglu G.
        Facet inclinations and interfacet angle of the distal radius on posteroanterior radiographs.
        J Hand Surg Am. 2020; 45: 65.e1-65.e8
        • Camus E.J.
        • Van Overstraeten L.
        Surgical technique of a radial wedge “camembert” osteotomy in Kienböck disease.
        Tech Hand Up Extrem Surg. 2012; 16: 75-79
        • Palmer A.K.
        • Glisson R.R.
        • Werner F.W.
        Ulnar variance determination.
        J Hand Surg Am. 1982; 7: 376-379
        • Paley D.
        • Axelrod T.S.
        • Martin C.
        • Rubenstein J.
        • McMurtry R.Y.
        Radiographic definition of the dorsal and palmar edges of the distal radius.
        J Hand Surg Am. 1989; 14: 272-276
        • Schernberg F.
        Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist: part 1: the standard and positional views.
        J Hand Surg Br. 1990; 15: 210-219
        • De Smet L.
        Ulnar variance: facts and fiction review article.
        Acta Orthop Belg. 1994; 60: 1-9
        • Garcia-Elias M.
        • An K.N.
        • Cooney W.P.
        • Lınscheıd R.L.
        Lateral closing wedge osteotomy for treatment of Kienböck’s disease: a clinical and biomechanical study of the optimal correcting angle.
        Chir Main. 1998; 17: 283-290
        • Watanabe K.
        • Nakamura R.
        • Horii E.
        • Mıura T.
        Biomechanical analysis of radial wedge osteotomy for the treatment of Kienböck’s disease.
        J Hand Surg Am. 1993; 18: 686-690
        • Hara T.
        • Horii E.
        • An K.N.
        • Cooney W.P.
        • Linscheid R.L.
        • Chao E.Y.
        Force distribution across wrist joint: application of pressure-sensitive conductive rubber.
        J Hand Surg Am. 1991; 17: 339-347
        • Tsumura H.
        The optimum correcting angle of wedge osteotomy at the distal end of the radius for Kienbock’s disease.
        J Jpn Soc Surg Hand. 1984; 1: 435-439
        • Yang G.
        • Partridge K.A.
        • Abdel-Mohti A.
        • McMullen A.J.
        • Shen H.
        Finite element analysis of osteotomy treatment for Kienbock’s disease.
        J Biomedical Science and Engineering. 2016; 9: 161-170
        • Razemon J.P.
        Pathological study of Kienboeck’s disease [in French].
        Ann Chir Main. 1982; 1: 240-242
        • Hulten O.
        About anatomical variations of the wrist bones [in German].
        Acta Radiol. 1928; 9: 155-168
        • Gelberman R.H.
        • Salamon P.B.
        • Jurist J.M.
        • Posch J.L.
        Ulnar variance in Kienböck’s disease.
        J Bone Joint Surg Am. 1975; 57: 674-676
        • Nakamura R.
        • Tanaka Y.
        • Imaeda T.
        • Miura T.
        The influence of age and sex on ulnar variance.
        J Hand Surg Br. 1991; 16: 84-88
        • D’Hoore K.
        • De Smet L.
        • Verellen K.
        • Vral J.
        • Fabry G.
        Negative ulnar variance is not a risk factor for Kienböck’s disease.
        J Hand Surg Am. 1994; 19: 229-231
        • Chung K.C.
        • Spilson M.S.
        • Kim M.H.
        Is negative ulnar variance a risk factor for Kienböck’s disease? A meta-analysis.
        Ann Plast Surg. 2001; 47: 494-499
        • Viegas S.F.
        • Wagner K.
        • Patterson R.
        • Peterson P.
        Medial (hamate) facet of the lunate.
        J Hand Surg Am. 1990; 15: 564-571
        • Rhee P.C.
        • Jones D.B.
        • Moran S.L.
        • Shin A.Y.
        The effect of lunate morphology in Kienböck disease.
        J Hand Surg Am. 2015; 40: 738-744
        • Watson H.K.
        • Ballet F.L.
        The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.
        J Hand Surg Am. 1984; 9: 358-365
        • Viegas S.F.
        • Tencer A.F.
        • Cantrell J.
        • et al.
        Load transfer characteristics of the wrist. Part II. Perilunate instability.
        J Hand Surg Am. 1987; 12: 978-985
        • Goldfarb C.A.
        • Hsu J.
        • Gelberman R.H.
        • Boyer M.I.
        The Lichtman classification for Kienböck’s disease: an assessment of reliability.
        J Hand Surg Am. 2003; 28: 74-80
        • Bain G.
        • MacLean S.B.
        • Lichtman D.
        Kienbock’s disease: Green’s hand surgery.
        in: Wolfe S.W. Hotchkiss R.N. Pederson W.C. Kozin S.H. Cohen M.S. Green’s Operative Hand Surgery. Elsevier, 2017: 639-659
        • Owers K.L.
        • Scougall P.
        • Dabirrahmani D.
        • Wernecke G.
        • Jhamb A.
        • Walsh W.R.
        Lunate trabecular structure: a radiographic cadaver study of risk factors for Kienbock’s disease.
        J Hand Surg. 2010; 35: 120-124