Kinbek's disease

Description:

Kinbek's (m. Kienbock) disease - an osteonecrosis of a semi-lunar bone. The disease has also other synonyms (an osteochondropathy of a semi-lunar bone, a wrist osteochondritis, traumatic osteoporosis of bones of a wrist, a lunatomalyation, an aseptic necrosis of a semi-lunar bone of a wrist, an avaskulyarny necrosis), but now is considered to be correct treatment "osteonecrosis" of a semi-lunar bone. It is for the first time described by the Austrian radiologist of R. Kienbock in 1910.

Kinbek etiologies:

It is considered that the single injury or constant traumatization (so-called microtraumatization) can serve as the reason of development of a disease that can lead to disturbance of blood supply of bones of a wrist.

Therefore Kinbek's disease meets more often at people  whose physical activity is connected with load of area of a radiocarpal joint. The semi-lunar bone takes the central place in a wrist, being located between a capitate bone of a wrist and a beam bone and therefore more than other bones it is injured at an exercise stress. The disease develops gradually and occurs most often at cutters, the joiners, mechanics, crane operators, persons working with the vibrating ustroustvo (jackhammers) can arise also at workers of other specialties. More often the leading hand is surprised (at right-handed persons - right, at lefthanders - left).

One more reason of a course of a disease of Kinbek - an inborn short ulna. In that case pressure  upon a semi-lunar bone increases and the osteonecrosis of a semi-lunar bone (Kinbek's disease) can develop.

Symptoms of a disease of Kinbek:

The essence of a disease consists in gradually accruing aseptic necrosis (or, more precisely an osteonecrosis) a semi-lunar bone which leads to its fragmentation and final fracture over time. All this is followed by wrist pain, in a radiocarpal joint. Pain amplifies at the movements and increases in process of progressing of a disease.
Disease stages:

First stage: The semi-lunar bone loses the blood supply, there can be a change.
Second stage: The bone becomes too firm (a bone sclerosis) because of insufficient blood supply.
Third stage: Bone collapse. The bone is fallen down, decreases in sizes, is fragmented (breaks up to pieces), fragments of a bone can migrate.
Fourth stage: The next bones are injured that privoit to arthrosis of joints of a wrist.

Further radiological its deformation, flattening along a longitudinal axis and shortening in the diameter are defined. Contours of a bone become uneven; in the center sites of an enlightenment which correspond to bone rassasyvaniye zones are defined. Are quite often noted narrowing of a joint crack as manifestation of the deforming osteoarthrosis. Regtgenelogichesky signs of a nearthrosis of a semi-lunar bone can be defined, pathological changes, the bone can become fragmented, i.e. break up to parts.  

In doubtful cases when the X-ray analysis does not allow to speak with confidence about the diagnosis, the magnetic and resonant tomography is carried out.

Treatment of a disease of Kinbek:

Treatment of a disease of Kinbek is defined by a disease stage. At initial stages of a disease the immobilization (conservative treatment) is used: the radiocarpal joint is immobilized a plaster or plastic splint or the special orthosis for three weeks. The immobilization purpose - creation of rest for a semi-lunar bone that can lead to regress of a disease at early stages, to recovery of blood supply of a bone due to germination of new vessels or recovery of a blood-groove on old blood vessels. If conservative treatment resulted in success, then the immobilization is stopped, but further obyazetelna control roentgenograms each 4-6 weeks within one year and if the disease progresses again, then are returned to an immobilization.

The eurysynusic physiotherapeutic methods of treatment in our country including novocainic blockade, mud cure, hydrosulphuric bathtubs of the proved effect have no and by and large are only visibility of treatment. It is possible that recovery of a blood-groove is promoted by the thermal procedures strengthening a blood stream, for example, a paraffinotherapy however for this purpose it is possible to use a usual hot-water bottle or a sack with sand or buckwheat.

When conservative treatment is inefficient, the disease progresses, and symptoms of a zaoblevaniye are rather strong and really disturb in life, resort to operational treatment.

Operational (surgical) treatment is defined by a disease stage.

Revaskulirizuyushchy operations. At early stages of a disease (1, 2 stages) it is possible to try to recover blood supply of a bone in the surgical way. For this purpose take a bone piece with the blood vessels entering it from the lower part of a beam bone (a forearm bone) and replace in a semi-lunar bone. Also free change of a krovosnabzhayemy bone rag from a crest of an ileal bone, from a metacarpal bone is possible. These operations отностя to microsurgical and they are very difficult in the technical plan. After operation the brush is immobilizrut a splint or the orthosis for 3-4 weeks, so that the replaced bone got accustomed and the blood stream was recovered. After that each 4 weeks carry out control rentgenegramma on which estimate healing process. As a rule, at successful microsurgery full engraftment of a transplant and recovery of a blood-groove in all semi-lunar bone takes 16-24 weeks.