Morbus Kienböck Stage II
It shows increased density in the lunate on plain radiographs
without a change in the shape, size, or relationship to other
carpal bones.
Morbus Kienböck Stage II
Morbus Kienböck Stage II T2 TSE cor
Morbus Kienböck Stage IIIb
Morbus Kienböck Stage IIIb (Extended fragmentation)
Morbus Kienböck Stage IIIb

Stage I:

  • May include a linear or compression fracture with normal lunate architecture and density.
  • Pain is similar to a wrist sprain with mild activity-related wrist pain and pain with loading in wrist extension.
  • Immobilization is widely used as therapy for Stage I disease.

Stage II:

  • This stage shows increased density in the lunate on plain radiographs without a change in the shape, size, or relationship to other carpal bones. Often referred to as the first stage with visible changes on radiographs.
  • Pain at this stage generally is more persistent. Treatment is still evolving. Joint-leveling procedures are often used.

Stage III:

  • This stage is associated with pain both at rest and with activity.
  • Stage IIIa: Fragmentation and deformation proximal(without fixed scaphoid rotation).
  • Stage IIIb: Extended fragmentation (with fixed scaphoid rotation).
  • This stage disease may be treated similar to Stage II with or without a revascularization procedure.
  • Often treated with proximal row carpectomy or limited intercarpal fusion.

Stage IV

  • Complete fragmentation
  • Kienbock’s Disease Advanced Collapse (KDAC) to illustrate the parallels between Stage IV disease and scapholunate dissociation advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC).
  • Treated with salvage procedures such as total wrist arthroplasty or total wrist arthrodesis.