Avascular Necrosis of Carpal Bones
Summary
Avascular necrosis of the carpal bones is a pathophysiological condition characterised by the death of bone tissue due to an interruption of blood supply within one or more of the eight small bones of the wrist. The lunate is most commonly affected, a phenomenon historically termed Kienböck’s disease, followed by the scaphoid (Preiser disease), the capitate and, more rarely, the trapezium. Clinical presentation includes chronic wrist pain, stiffness and reduced range of motion, often without a history of significant trauma. Early stages may be radiographically occult, with magnetic resonance imaging (MRI) providing the earliest diagnostic clues through altered marrow signal. Progression leads to fragmentation, collapse of the articular surface and secondary osteoarthritic change. Management strategies range from immobilisation and conservative measures to surgical interventions such as revascularisation procedures, proximal row carpectomy, vascularised bone grafting or joint fusion. Early detection and tailored therapy are crucial to preserving carpal alignment and function, with consideration of patient age, activity level and stage of necrosis guiding the choice of intervention. Emerging research continues to refine diagnostic protocols, surgical techniques and our understanding of disease mechanisms, aiming to improve outcomes and limit progression to debilitating arthrosis.
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Avascular Necrosis of Carpal Bones publication trend
The graph below shows the total number of articles in avascular necrosis of carpal bones across all publications each year (not limited to Nature Index journals).
Technical terms
Avascular necrosis: Death of bone tissue due to interruption of blood supply.
Scaphoid: One of the proximal carpal bones commonly affected by avascular necrosis.
Conservative treatment: Non-surgical management including immobilisation and orthoses.
Vascularised bone graft: Surgical transfer of bone tissue with its own blood vessels to restore blood flow.
Magnetic resonance imaging (MRI): Imaging modality that detects early changes in bone marrow signal.
References
- Preiser disease in a child before complete ossification of the scaphoid: a case report. BMC Musculoskeletal Disorders (2022).
- A Nine-Year Follow-Up of Stage II Preiser’s Disease Treated With a Temporary Dorsal Wrist-Spanning Plate: A Case Report. Cureus (2023).
- A case of avascular necrosis of capitate bone in an air compressor jack hammer worker. Journal of Research in Clinical Medicine (2019).
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