56-year-old male - Classifying instability in the short axis

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Kienbock’s disease stage 3B versus 4. Fell off a ladder; now with radial-sided pain.

Long- and short-axis fat- and water-weighted images were obtained before and after contrast administration. 10cc of OptiMARK injected. 

  • Skeleton:
    • Healing radial fracture comminuted with post fracture deformity and hypertrophy of the radial styloid. Penetrating lunate fossa chondromalacic erosions. Nonpenetrating chondromalacia scaphoid fossa. 
  • Lunate:
    • Exhibits VISI posture deformity segmental area of necrosis radially collapse and ulnar translocation of the lunate with failure of the scapholunate ligament. 
  • Articular:
    • Multiple erosions are present involving the distal ulna the radius is previously described. The deformed lunate and scattered throughout the carpus including the 1st CMC and the carpometacarpal junctions. 
  • TFC:
    • Chronic attritional tear of the inner third of the TFC with TFC degeneration but no acute traumatic tear. 
  • Conformity and alignment:
    • Anterior rotation of the scaphoid virtually horizontal or having an AP orientation consistent with failure of the radioscaphocapitate ligament. 
  • VISI posture of the irregular deformed lunate as previously described with post fracture deformity and arthropathic erosions and hypertrophic spurring. 
  • Proximal migration of the capitate consistent with scapholunate failure and VISI posture. 
  • Postcontrast MRI:
    • Approximately 30-40% of the proximal portion of the lunate nonenhancing and avascular with collapse as described. 
  • Staging:
    • Using the Stahl classification of Kienbock’s disease not only does the patient exhibit lunate collapse with fixed scaphoid rotation degenerative changes around the lunate are conspicuous.

Stage 4 Kienbock’s disease with details described in the body of the report.

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