KINBEKA DISEASE

From Big Medical Encyclopedia

KINBEKA DISEASE (B. Kienbock, the Austrian radiologist, 1871 — 1953) — the nonspecific isolated damage of a semi-lunar bone of a brush which is characterized by the typical progressing deformation of dystrophic character.

For the first time the specified pathology of a semi-lunar bone is found by Peste in 1843 who regarded it as a result of a change. Kinbek in 1910 gave the first systematized a wedge, and rentgenol, the description of a disease, having called it a traumatic malacia of a semi-lunar bone. In the subsequent this defeat was called traumatic osteoporosis, a cystous osteodystrophy, hron, an osteitis, a malacia, an aseptic necrosis, an osteochondropathy.

To. meets at persons from 20 to 40 years which are engaged manual physical more often. work. Women get sick slightly less often than men. The right hand is surprised more often.

An etiology and a pathogeny

the Aetiology and a pathogeny To. are not found out. A number of hypotheses from which any was not recognized moved forward. Considered that the reason To. there can be circulator frustration owing to a rupture of sheaves and vessels feeding a semi-lunar bone; the circulator frustration resulting from an embolism; a single injury about primary compression fracture of a semi-lunar bone; hron. The traumatization accompanied with microfractures, etc. As To. find in patients with the finished growth of bones and the tendency to the subsequent recovery of normal structure of a semi-lunar bone is noted, it is not necessary to refer defeat, according to D. T. Rokhlin, to group of osteochondropathies. Histologists never found specific only to K.b. the changes of a semi-lunar bone testifying to a special bone disease. At the same time the possibility of existence of the different reasons leading to the same deformations of a semi-lunar bone was allowed. Modern researches confirm that To. is not homogeneous nozol, a form, and represents polymorphic defeat, in a basis to-rogo there can be aseptic necroses, effects traumatic or patol, changes.

The disease of a semi-lunar bone can result from its microtraumatization at hron, overloads of a wrist joint (see. Radiocarpal joint ), and also owing to compression changes at indirect injuries of a wrist joint and patol, changes at not recognizable fibrocystic defects of a semi-lunar bone. The contributing factor is minus option of an ulna (high standing of its head) which is found at To. by 8 — 12 times more often than is normal. A role of dislocations of a semi-lunar bone in emergence To. it is rejected.

Pathological anatomy

the Main changes of a semi-lunar bone have dystrophic character. Distinguish five stages of a disease. The I stage — the beginning of dystrophic process in bone substance at safety of a shape of a semi-lunar bone. In the II stage moderate deformation of its impression changes with a prelum of bone beams results. To the III stages there is a rassasyvaniye of a bone tissue on border with sites of a necrosis and substitution by their fibrous fabric; at the same time the integrity of a cartilage and a subchondral plate is broken preferential from the proximal joint surface of a semi-lunar bone, deformation progresses. In the IV stage deformation accrues and there is a vertical fragmentation of a semi-lunar bone. In the V stage there are secondary changes in a type of the deforming arthrosis of a radiocarpal joint. Consecutive transition of one stage to another is observed not always. Regarding cases process comes to an end with insignificant deformation of a semi-lunar bone (a «high-quality» form), in others — quickly there occurs flattening and its fragmentation (a «malignant» form). Accurate correlation between rentgenomorfol. and the wedge, a picture of a disease is absent.

A clinical picture

the First symptoms of a disease — a sensation of discomfort, non-constant pains in the basis of a brush at the forced movements and overloads. Pains at rest are not typical. Quite often the beginning To. proceeds it is hidden. The acute pain for the first time results patol. fracture of a semi-lunar bone. Gradually pains at the movements and loadings become more intensively and more for a long time though also remissions are possible. There is a resistant limited swelling on the back of the basis of a brush, restriction of movements in a wrist joint accrues, the hand becomes weak, the atrophy of muscles of a forearm develops. In late stages the crunch at the movements is felt.

In some cases To. for many years proceeds asymptomatically and is established accidentally.

Complications

the Progressing deformation of a semi-lunar bone is followed by a resistant rotational incomplete dislocation of a navicular, and frustration of biomechanics of a wrist joint leads to the expressed deforming arthrosis. In some cases the prelum of a median nerve in a carpal tunnel is possible; there can sometimes be patol, ruptures of sinews of sgibatel or razgibatel of fingers.

Diagnosis

Fig. 1. Roentgenograms of a wrist joint (at the left in a direct projection, on the right — in side) at Kinbek's disease in a stage of fragmentation: shooters specified the affected semi-lunar bone.

The wedge, the diagnosis in an initial stage of a disease is difficult, however at the corresponding symptoms (non-constant pains in the basis of a brush, local morbidity in a semi-lunar bone, strengthening of pain at limit bending and extension of a brush) it is possible to assume To.

For establishment of the diagnosis the X-ray analysis is decisive, but at this research of change of a semi-lunar bone it is possible to find not earlier than 2 — 3 months from the beginning of a disease. On the roentgenogram change of a form and increase in density of a shadow of a semi-lunar bone is characteristic. The shadow gets it the irregular triangular shape, height decreases, contours of a bone remain accurate, but uneven, wavy. In a stage of fragmentation the bone is divided into fragments (fig. 1), various in a form, the sizes and density, each of which has uneven outlines. In III and IV stages the semi-lunar bone remains flattened, adjacent departments of joint cracks are expanded. Further there is gradual partial reduction of the drawing of structure and a shape of a bone. The semi-lunar bone remains deformed, and at the edges of it labelloid bone growths appear. Similar growths arise also on adjacent joint surfaces (the V stage). The joint crack from expanded becomes narrowed. In some cases in a cavity of a joint intra joint bodies come to light.

For the purpose of specification of nature of changes in a bone, especially in initial stages of development patol, process, use is reasonable tomographies (see) and a X-ray analysis with direct blowup.

Differential diagnosis carry out with the stenosing tendovaginitis (see. Tendovaginitis ), deep ganglion (see), with injury of a polulunno-carinate ligament, an incomplete dislocation of a semi-lunar bone, with fibrocystic defect.

On kliniko-rentgenol, a picture K. it is necessary to differentiate with the isolated damages of a semi-lunar bone of a tubercular, tumoral or inflammatory origin. At a tubercular osteitis and the isolated rhematoid defeat the semi-lunar bone is deformed and reduced in sizes due to destruction, but not flattening and fragmentation as it takes place at To. Inflammatory process is characterized by osteolytic changes with depression of the drawing of structure whereas at To. density of a bone tissue is increased.

Treatment

Fig. 2. The scheme of a polulunno-beam artificial ankylosis a cylindrical transplant at partial destruction of a semi-lunar bone: 1 — formation of cylindrical defect (the outlined circle) on a joint between struck with semi-lunar and beam bones, on the right — the same in a side projection (the dotted line designated limits of defect); 2 — the cylindrical transplant is inserted into educated defect shaded); the wrist joint is fixed by a spoke, on the right — a side projection.
Fig. 3. The flow diagram of substitution of a remote semi-lunar bone a silicone endoprosthesis (according to Svensson): the pin of a prosthesis is implemented in a trihedral bone (the prosthesis is specified by an arrow).
Fig. 4. The scheme of reconstructive operation with movement of a head of a capitate bone and with a partial artificial ankylosis of a wrist joint (modification of operation of Graner): 1 — the affected semi-lunar bone is specified by an arrow; level of an osteotomy of a capitate bone is shown by a dashed line; 2 — the semi-lunar bone is removed, the head of a capitate bone is temporarily taken; 3 — to the place of a semi-lunar bone of a replantirovan the head of a capitate bone is also fixed by a spoke; 4 — between fragments of a capitate bone the cylindrical bone autograft is inserted shaded), the wrist joint is fixed by spokes.

Treatment a long time was limited to conservative actions (an immobilization, physical therapy) or removal of a semi-lunar bone. The immobilization in a circular plaster bandage within 2 — 3 months is acceptable only at early stages at the «high-quality» course of a disease; in late stages the immobilization only reduces pain and temporarily stops destruction of a semi-lunar bone.

Removal of a semi-lunar bone as independent operation was not repaid. No later than the II—III stage of a disease recommend operations with shortening of a beam bone or lengthening of an ulna; results of these interventions are not always reliable and resistant. The same can be told about a partial ekskokhleation of a semi-lunar bone with sealing of a cavity a spongy bone.

By an effective method of operational treatment To. are partial artificial ankyloses (see) a wrist joint: polulunno-beam, carpal, radiocarpal, etc. Performance of partial artificial ankyloses by means of cylindrical bone plastics according to Ashkenazi (fig. 2) is applied.

At final fractures of a semi-lunar bone when it is not possible to keep it, make reconstructive and recovery operations. Many supporters find a method of substitution of a semi-lunar bone silicone endoprostheses (fig. 3); however Endoprosthesis replacement (see) it cannot be recommended to the persons performing heavy handwork. Favorable results bring reconstructive operations with movement of a head of a capitate bone and a partial artificial ankylosis of a wrist (fig. 4). The immobilization after operative measures proceeds from 6 to 12 weeks. Recovery treatment includes to lay down. gymnastics, massage, heat baths. For prevention of the deforming arthrosis at a part of patients it is shown a dignity. - hens. treatment 4 — 6 months later after operation.

The forecast

the Current and an outcome To. it is difficult to predict. The absolute recovery even at early the recognizable defeats is observed seldom. Repeated overloads or injuries of a wrist joint lead to progressing of deformation of a semi-lunar bone, to strengthening funkts, frustration. If To. it is distinguished in late stages at the persons who are engaged physical. restriction of working capacity is already available work, in these cases usually; improvement of function is reached only by operation.

See also Osteochondropathy .


Bibliography: Ashkenazi of A. I. Polulunno-lucheva an artificial ankylosis at an aseptic necrosis of a semi-lunar bone, Ortop, and travmat., No. 7, page 33, 1969; it e, About indications to operational treatment at Kinbek's disease, in book: Sovr, methods of treatment of damages and diseases of a brush, under the editorship of M. V. Volkov and S. I. Degtyareva, page 115, M., 1975; Ashkenazi A. I. and Berman A. M. Morphological options of a disease of Kinbek, Ortop, and travmat., No. 8, page 59, 1974; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 2, page 280, M., 1964; E l to and M. A N. Occupational surgical diseases of hands, page 201, L., 1971; G of n e of O. and. lake of Arthrodesis of the carpal bones in the treatment of Kienbock's disease, J. Bone Jt Surg., v. 48-A, p. 767, 1966; Kienbock R. t)ber traumatische Malazie des Mondbeins und ihre Folgezu-stande, Entartungsformen und Kompessions-frakturen, Fortschr Rontgenstr., Bd 16, S. 77, 1910—1911; Swanson A. Silicone rubber implants for replacement of the carpal scophoid and luncte bone, Orthop. Clin. N. Amer., v. 1, p. 299, 1970.

A. Ashkenazi; M. K. Klimova (rents.).

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