56-year-old male - Classifying instability in the sagittal plane
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.
- Healing radial fracture comminuted with post fracture deformity and hypertrophy of the radial styloid. Penetrating lunate fossa chondromalacic erosions. Nonpenetrating chondromalacia scaphoid fossa.
- Exhibits VISI posture deformity segmental area of necrosis radially collapse and ulnar translocation of the lunate with failure of the scapholunate ligament.
- 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.
- 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.
- 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.
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