Avascular necrosis of the hip.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Competing interestsThe BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests is here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests 20. Hand Clin. 2022 Nov;38(4):393-403. doi: 10.1016/j.hcl.2022.03.003. The Pathoanatomy and Biomechanics of Kienböck Disease. MacLean SBM(1), Hu M(2), Bain GI(3). Author information: (1)Department of Orthopaedic Surgery, Tauranga Hospital, 829 Cameron Road South, Bay of Plenty, Tauranga, North Island 3112, New Zealand. Electronic address: Simonmaclean81@gmail.com. (2)Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia 5042, Australia. (3)Hand and Upper Limb Surgery, Flinders University, Bedford Park, Adelaide, South Australia 5042, Australia. Kienböck disease (KD) involves osseous, vascular, and chondral aspects of the lunate and wrist. We present our theories on the etiology and pathogenesis of the condition based on basic science models, seminal literature, personal case experience, and kinematic observations of the Kienböck wrist. Three phenotypes of Kienböck disease occur, and each tends to have different morphology, rates of progression, and disease pattern. The lunate fracture in KD is well-recognized but different fracture types can occur. Dynamic assessment of the Kienböck wrist allows assessment of the complex kinematics of KD. Disease onset and progression require a "perfect storm" of risk factors. Copyright © 2022 Elsevier Inc. All rights reserved. DOI: 10.1016/j.hcl.2022.03.003