Subchondral bone mineralization patterns in Kienböck's disease

Abstract

Iwasaki et al 1 Iwasaki N Minami A Miyzawa T Kaneda K Force distribution through the wrist joint in patients with different stages of Kienböck's disease: using computed tomography osteoabsorptiometry. J Hand Surg. 2000; 25A: 870-876 Abstract Full Text PDF Scopus (45) Google Scholar applied a method of computed tomography absorptiometry, which was originally developed at the Anatomical Institute in Munich. They used the technique to analyze the patterns of subchondral bone mineralization in the distal surface of the radius in healthy subjects and in patients with Kienböck's disease. In my and my colleagues' experience 2 Giunta R Löwer N Kierse R Rock C Wilhelm K Müller-Gerbl M Altered patterns of subchondral bone mineralisation in Kienböck's disease. J Hand Surg. 1997; 22B: 16-20 Google Scholar , 3 Giunta R Lanz U Rock C Wilhelm K Müller-Gerbl M Uber die Beanspruchung des Handgelenks bei Mondbeinnekrose—Eine morphologische Untersuchung am Lebenden. Handchir Mikrochir Plast Chir. 1998; 30: 158-164 PubMed Google Scholar , 4 Giunta R Krimmer H Krapohl B Treutlein G Lanz U Müller-Gerbl M Patterns of subchondral bone mineralization in the wrist after midcarpal fusion. J Hand Surg. 1999; 24A: 138-147 Crossref Google Scholar this new morphologic tool allows an indirect semiquantitative assessment of long-term stresses acting in wrist joint. It is not a technique, however, that allows direct measurement of intraarticular forces, as claimed in the title of the article by Iwasaki et al. These investigators confirm our results obtained in 12 patients with Kienböck's disease 2 Giunta R Löwer N Kierse R Rock C Wilhelm K Müller-Gerbl M Altered patterns of subchondral bone mineralisation in Kienböck's disease. J Hand Surg. 1997; 22B: 16-20 Google Scholar , 3 Giunta R Lanz U Rock C Wilhelm K Müller-Gerbl M Uber die Beanspruchung des Handgelenks bei Mondbeinnekrose—Eine morphologische Untersuchung am Lebenden. Handchir Mikrochir Plast Chir. 1998; 30: 158-164 PubMed Google Scholar : contrary to the anticipated presence of a predominant stress in the lunate compartment as a sign of overloading, patients in progressive stages show the highest density values in the compartment of the scaphoid. We had therefore concluded that the main stress in the scaphoid compartment might be a secondary effect, which is to be regarded as the expression of the advancing destruction of the lunate and consequent loss of load transmission through this compartment. This hypothesis is also supported by the fact that, in our patients with progressive stages of Kienböck's disease, the density maximum in the lunate fossa was absent in 2 patients.