Avascular Necrosis of Carpal Bones

Avascular necrosis of the carpal bones is a rare entity. By far, the most frequent carpal bone compromised is the lunate bone, the so called Kienböck’s disease. In the present chapter, Kienböck’s disease (or Lunate Bone Osteomalacia or Avascular Necrosis of the Lunate) is described beginning with its epidemiology and pathophysiology as well as etiologic theories, though no single theory is supported by enough evidence yet. The vascular and the mechanical theories are described with their respective bases. The radiologic, magnetic resonance imaging (MRI), and arthroscopic classifications are described with their respective clinical relevance. Clinical features, radiologic, and MRI diagnostic tools are further discussed in this chapter, with a special emphasis made on differential diagnoses. Different treatment principles and surgical techniques such as joint leveling, mechanical decompression methods, and revascularization procedures are described. As superiority of any procedure over the other is yet to be proven for each disease stage, the authors share their preferred method of treatment for each Lichtman stage. Finally, salvage procedures for advanced stages with irreversible damage are further listed. A brief section is devoted to other carpal bone necrosis, including Preiser disease or scaphoid avascular necrosis.