Lunate malacia and its treatment with lunate excision

Abstract

The malazie of the Os lunatum ist one of the most frequent aseptic bone-necroses. It is found mainly with patients between the age of 25 and 35 years. That means that most of our patients are working full time. We give a clinical report of the disease and discuss the different aetiopathogenetic mechanisms according to the literature. In addition we give a cronological survey over possible methods of treatment both conservative and operative. We describe our method of treatment introduced by Mittelmeier (1965). In this method the gap that arises by resection of the Os lunatum is filled with a helved piece of soft tissue. This filling-material consists of a volar helved piece of the joint-capsula and of epitendinosus tissue of the deep flexor-tendons. In the Orthopaedic University Hospital in Homburg/Saar we have a casuistic of 42 cases treated by this method. This is the biggest casuistic in the literature as fare as we know. We report our results of treatment based an a clinical and X-ray examination. With this method we had satisfying longterm results in 80% of the cases. Even after years we hardly found an arthrosis between Os naviculare and radius. According to these results we recommend the method after Mittelmeier for the treatment of the malazie of the Os lunatum even for severe cases with fragmentation and collaps of the Os lunatum.