Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck's disease)

Abstract

To confirm the hypothesis that venous congestion plays a role in idiopathic lunate necrosis (Kienböck's disease), intraosseous pressure in 12 normal and 12 necrotic lunates was measured. Intraosseous pressure in the capitate of 12 healthy subjects served as reference measurement. The intraosseous pressure was recorded in neutral position and 60 degrees extension of the wrist under normotensive conditions and during venous stasis. In all groups, the mean intraosseous pressure rose significantly with extension of the wrist, with the largest increase being 92.3 mmHg for necrotic lunates, followed by 40.3 mmHg for normal lunates, 6.9 mmHg for normal capitates and during venous stasis, 26.6 mmHg for necrotic lunates, 26.1 mmHg for normal lunates, and 5.9 mmHg for normal capitates. In some necrotic lunates, the intraosseous pressure during extension exceeded the arterial blood pressure, which can be explained by mechanical deformation of the bone. In neutral position, no significant differences in pressure were found between normal lunates and capitates. A significant difference was found for venous stasis and extension. The intraosseous pressure rise in the normal lunate in extension was slightly higher than the pressure found during venous stasis. The intraosseous pressure differed significantly (by 56.9 mmHg) between normal and necrotic lunates in extension. These data support the hypothesis that impairment of venous drainage plays a role in lunate necrosis and that the lunate can be considered as a venous bone at risk.