Kienböck's disease: paradoxes and plausibility
Seance of wednesday 14 september 2022 (Communications libres)
DOI number : 10.26299/kyf7-bh84/emem.2022.25.05
Abstract
Kienböck disease was officially described in 1910 by Robert Kienböck, an Austrian radiologist.
Today, it is defined as an aseptic osteonecrosis of the lunate, the cause of which remains debated.
Its often complicated evolution in young people from 17 to 77 years old leads to discuss a surgical treatment.
The most frequently performed surgery at present consists of a radius shortening osteotomy. This proposal comes from a publication by Olle Hultén almost a century ago.
What if Kienböck was not the first to present it?
What if Kienböck had not described the disease that bears his name?
What if Hultén had not proposed the radius shortening osteotomy?
What if an osteotomy could still be useful? But how?
By reviewing the bibliography, it seems that we can trace the evolution of the concepts proposed to understand this pathology.
Two paradoxes then emerge, still present on the scientific scene.
-Kienböck did not describe the pathology as we understand it today. He sought to understand and explain the origin of certain fractured lesions of the lunate that radiography, which had just been invented, made it possible to discover in living patients before the autopsy stage.
-The shortening of the radius was imposed almost by chance. But this is not a proposal of Hultén.
This bibliography helps us to better understand the construction of the idea of Kienbock's disease, to understand the variation of its concepts over time, and probably to imagine it differently for the next decade.
Key words : Kienböck's disease, History, Osteotomy.
Today, it is defined as an aseptic osteonecrosis of the lunate, the cause of which remains debated.
Its often complicated evolution in young people from 17 to 77 years old leads to discuss a surgical treatment.
The most frequently performed surgery at present consists of a radius shortening osteotomy. This proposal comes from a publication by Olle Hultén almost a century ago.
What if Kienböck was not the first to present it?
What if Kienböck had not described the disease that bears his name?
What if Hultén had not proposed the radius shortening osteotomy?
What if an osteotomy could still be useful? But how?
By reviewing the bibliography, it seems that we can trace the evolution of the concepts proposed to understand this pathology.
Two paradoxes then emerge, still present on the scientific scene.
-Kienböck did not describe the pathology as we understand it today. He sought to understand and explain the origin of certain fractured lesions of the lunate that radiography, which had just been invented, made it possible to discover in living patients before the autopsy stage.
-The shortening of the radius was imposed almost by chance. But this is not a proposal of Hultén.
This bibliography helps us to better understand the construction of the idea of Kienbock's disease, to understand the variation of its concepts over time, and probably to imagine it differently for the next decade.
Key words : Kienböck's disease, History, Osteotomy.