Necrosis Of Lunate Research Articles

Volar Lunate Dislocation: A Case Report

Introduction: Perilunate dislocations are rare high-energy injuries which may often have the potential to cause lifelong disability of the wrist if not addressed optimally. Hence, early recognition, diagnosis, and intervention are of paramount importance in the restoring function and prevention of morbidity. Lunate dislocations are the fourth and last stage of perilunate dislocations being extremely rare, with volar dislocations representing <3% of perilunate dislocations. Case Report: A 24-year-old man suffered from an alleged history of fall from a bike on an outstretched hand following which he developed complaints of pain and swelling in the right wrist. On examination, the patient has relative sensory loss over the lateral half of the palm with no vascular deficit. An accurate range of motion could not be documented due to severe pain. Standard digital X-rays revealed lunate displaced and angulated volarly with a typical “spilled teacup” appearance along with radial and ulnar styloid fractures. Management: The patient was initially given an attempt of closed reduction which was not successful and was followed with open reduction and internal fixation with both volar and dorsal approach with Kirschner wires. The patient’s wrist was immobilized for 6 weeks with below elbow cast with the removal of k wires at 8 weeks after which wrist ROM exercises were started. Results: The patient was followed up for 6 months and now has a functional range of motion of the wrist with no sensory deficit and is able to continue with his profession as a car mechanic. Conclusion: Mayfield progression Stage 4 perilunate dislocations are uncommon with a poor prognosis if not addressed timely. Hence, these injuries need to be identified early and optimally managed with surgical intervention for a favorable outcome. Keywords: Perilunate dislocation, carpal bones, avascular necrosis of lunate, wrist trauma, carpal instability

Ulnar Variance in Athletes: A Scoping Review.

Ulnar variance (UV) is a measurement of the relative locations of the radius and ulna that may become perturbed in athletic populations. Positive UV can be associated with wrist pathologies often treated conservatively or surgically and may result in interruption of sports participation. This scoping review aims to summarize diagnostic measures of UV in athletes, describe its relation to separate wrist conditions, and present treatment strategies for symptomatic UV. A systematic search was created and modified for PubMed, CINAHL, Embase, and SPORTDiscus including articles from inception until February 2, 2022. Articles including UV characterization, imaging modality style, and an athletic population were searched across multiple databases. A scoping review was designed to identify the methods for imaging UV in athletic populations following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Level 4. The specific athletic population, imaging modality, measurement style, wrist pathology association, and surgical management of UV were extracted. A total of 4321 records were screened independently for eligibility: 22 met inclusion criteria. Eight sports comprised the analysis. All studies referenced conventional radiography to diagnose UV; 50% specified the posteroanterior, 18.2% anteroposterior, and 13.6% pronated, gripping radiographs. Hafner's method (7×), Palmer's technique (2×), and the method of perpendiculars (3×) were used to measure UV. Athletes displayed more positive UV than nonathletes and UV became more positive over time in longitudinal studies. Triangular fibrocartilage complex tears, focal lunate necrosis, and ulnar abutment were associated with positive UV. Ulnar shortening osteotomy was the most performed operation for positive UV. Conventional radiography is the gold standard for imaging UV in athletes. Hafner's method is the most commonly used radiograph measurement technique. Wrist pathology in athletic populations may indicate positive UV in need for operative management.

Decreased Complication Rate Using Partially Threaded Compared With Fully Threaded Compression Screws in 4 Corner Arthrodesis: A Retrospective Study.

Scapho-lunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist are the most common types of wrist arthritis. We compared the union rate and complication profile of patients with SLAC and SNAC wrist undergoing 4 corner arthrodesis with partially threaded or fully threaded headless compression screws. A single-center retrospective review was conducted to identify all patients treated for SLAC and SNAC with 4 corner fusion using headless compression screws from 2016 to 2021. A total of 33 patients undergoing surgery on 35 wrists were identified and included in the study. Demographics, comorbidities, complication profile, and radiographs were collected and compared between groups. One hundred percent (16/16) of partially threaded and 84.2% (16/19) of fully threaded screws demonstrated union by minimum 10-week follow-up. The total complication rate (avascular necrosis of lunate, screw loosening, etc.) was 31.4%; 52.6% of wrists implanted with fully threaded screws experienced complications compared with a 6.3% complication rate with partially threaded screws. The difference was statistically significant between the 2 groups (P = .004). Four corner arthrodesis using antegrade compression screws is an effective, reproducible method to achieve fusion in the wrist. The use of fully threaded screws was associated with more complications than with partially threaded screws, although union rate was not significantly different. Future studies with larger sample sizes would be useful to fully elucidate differences between these 2 constructs.

Vascularized Bone Grafts from the Lateral Femoral Condyle for the Treatment of Avascular Lunate Necrosis (Kienböck's).

Avascular necrosis of the lunate (Kienböck's disease) is rare and one of the main causes of progressive painful arthritis, requiring surgical intervention. Various approaches have shown benefits in treating Kienbock's disease but with limitations. The article aims to analyze the functional outcome using lateral femoral condyle free vascularized bone grafts (VBGs) as the first choice of treatment for Kienböck`s. This was a retrospective analysis of 31 patients with Kienbock's who had microsurgical revascularization or reconstruction of the lunate between 2016 and 2021 using either corticocancellous or osteochondral VBGs from the lateral femoral condyle. The characteristics of lunate necrosis, choice of VBG and postoperative functional outcome were reviewed. Corticocancellous VBGs were used in 20 patients (64.5%), while osteochondral VBGs in 11 patients (35.4%). The lunate was reconstructed in 11 patients, revascularized in 19 patients, and one patient received augmentation of a luno-capitate arthrodesis with a corticocancellous graft. We noted postoperative irritation of the median nerve (n = 3) and screw loosening requiring removal (n = 1) as minor complications. All patients had complete graft healing at eight-month follow-up and acceptable functional outcomes. Free VBG from the lateral femoral condyle represent a reliable method of lunate revascularisation or reconstruction in advanced Kienböck's. Their main advantages are the constant vascular anatomy, straightforward graft harvesting technique and possibility to harvest several graft types according to the requirements at the donor site. Postoperatively, the patients become pain-free and have an acceptable functional outcome.

Novel Technique in Late Stage Avascular Necrosis of Lunate: Tendon Interposition and Ligament Reconstruction with ECRL Tendon– A Case Report

Aim: To evaluate clinical and functional results of extensor carpi radialis longus tendon ball interposition for treatment of late stage avascular necrosis of lunate (kienbock’s disease).
 Materials and Methods: Patient with stage 4 kienbock’s disease was treated with excision of lunate and ecrl tendon interposition to fill the cavity of the excised lunate bone. Tendon was split. One half was left in situ and the other was used to fill the cavity by passing it to the scaphoid and triquetrum. This also helps to maintain intercarpal stability. Functions were assessed using grip strength, range of movement of wrist, quick dash and visual analogue score. Radiological examination was performed to assess carpal height ratio and progression of arthritis.
 Results: Long and bulky ecrl tendon acts as a spacer to fill the excised lunate. it also provides scapho lunate and lunate triquetral ligament reconstruction for inter carpal stability.
 Conclusion: ECRL tendon used for interposition with reconstruction seems to be an effective treatment modality for late stage of kienbock’s disease.

Bilateral Kienböck’s disease with bilateral negative ulnar variance: a case report

Purpose: Kienböck’s disease usually occurs unilaterally on dominant hands. As such, bilateral avascular necrosis of the lunate, in concurrence with bilateral negative ulnar variance (NUV), is a very rarely described condition.
 Case report: The case of a patient diagnosed with bilateral avascular necrosis of the lunate is presented. Plain film and magnetic resonance imaging confirmed bilateral NUV was also present.
 Conclusions: Although the relationship between Kienböck’s disease and NUV remains unclear, the bilateral concurrent appearance of both might instigate a discussion of the possible etiology of avascular lunate necrosis.

Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique

To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique. Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. There were significant differences in the longitudinal and transverse diameters between pisiform and lunate ( t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness ( t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side ( P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides ( P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch ( P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch ( P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch ( P>0.05). But the differences between the other vascular pedicles were significant ( P<0.05). There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck's disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.

Metaphyseal Core Decompression of the Distal Radius for Early Lunate Necrosis.

Background: Metaphyseal core decompression of the distal radius (MCD) is clinically effective in early lunate necrosis without changing individual wrist mechanics. Its concept is based on the induction of physiologic mechanisms known as physiologic fracture healing response. However, this biological concept does not yet have its place in the historically developed mechanical concepts about Kienböck's disease and requires more detailed clarifications to understand when a change of individual wrist mechanics might be unnecessary. Methods: Thirteen consecutive cases, Lichtman stage I (n = 1) or II (n = 12), confirmed by conventional MRI, were treated by MCD. Time off work, changes in magnetic resonance imaging of the lunate, as well as clinical outcome using modified Mayo wrist score were evaluated at final follow-up. Results: Return to work was at six (1-10) weeks after surgery. MRI controls at short-term generally demonstrated stop of progression and signs of bone healing. Independently from ulna variance complete signal normalization was observed in six and a distinct, yet incomplete decrease of lunate bone marrow edema and zones of fat necrosis was confirmed in further six cases after a mean of 21 (13-51) weeks. One patient had radiographic controls only, stating normal healing at 56 months. After a mean follow-up of 37 (12-70) months the clinical outcomes were excellent in eleven and good in two cases (mean 95% in modified Mayo wrist score). Conclusions: In stage I and II lunate necrosis MCD stops disease progression, it improves clinical symptoms and induces normalization of lunate bone signal alterations in MRI. Findings suggest that stage I and II lunate necrosis can be effectively treated without alterations of individual wrist mechanics. Future studies are necessary to readjust common concepts regarding Kienböck's disease, especially focusing on conservative therapy.

Upper Limb Non - Traumatic Affections in a Rural Tertiary Health Care Center

Introduction : Non - traumatic upper limb disorders are not uncommon. These may range from non - specific myalgia &amp; fibro - fasciitis to specific disorders of joints and bones of the upper limb bones. Frequent key board use is also becoming a new etiologic factor. Material &amp; Methods : The present prospective study was done in rural tertiary health care facility on admitted cases having upper limb non - traumatic disorders. Their pre - treatment functional status was assessed using 20 items Upper Extremity Function Index (UEFI) developed by Stanford PW et al. The data was analyzed to find the frequency of various disord ers. Observations &amp; Results: Out of total 41 cases, male female ratio was 2.7:1. The maximum patients 19 (46.34%) were in the age group 02 to 20 years and the least 02 (4.87%) &gt; than 60 years. The maximum cases, 20 (48.78%) were of bone tumors, benign in 1 6 cases and malignant in 04 cases. Other pathologies noted were, rotator cuff injury, tuberculosis, peri - arthritis shoulder, tennis elbow, nerve involvement, avascular necrosis of Lunate, inflammatory arthritis and De Quervain’s disease. As per the Upper E xtremity Functional Index, the scores ranged from 0 to 80. The minimum scores were seen in patients having gross neurological deficit in upper limb.

Open reduction and internal and external fixation combined with anchor repair of intercarpal ligament for the treatment of peripheral injury of lunate bone

To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy. From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed. All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair. The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.

Kienbock’s disease, Avascular Necrosis of Lunate: A Clinico-anatomical Insight

Kienbock’s disease, Avascular Necrosis of Lunate: A Clinico-anatomical Insight

Etiology, diagnostics and classification of lunate bone necrosis

Kienböck's disease, also known as avascular necrosis of the lunate bone describes the slowly progressive osteonecrosis of the lunate bone with secondary development of osteoarthritis and carpal collapse. In order to emphasize the atraumatic origin of the disease, this is normally referred to as aseptic, idiopathic or avascular lunate necrosis. There are thought to be anumber of factors predisposing to Kienböck's disease, such as ulnar negative variance, the shape of the lunate itself and various types of vascular anatomy. The ongoing development of radiographic techniques in recent years has contributed to abetter understanding of the progression of the disease and led to amodification of the standard classifications. New sophisticated classification methods provide the basis for adifferentiated treatment. This article provides an overview of the current state of knowledge about the etiology and pathogenesis as well as the clinically relevant diagnostic procedures and classifications.

ARTHROSCOPIC ASSESSMENT OF THE WRIST WITH KIENBÖCK'S DISEASE.

ABSTRACTObjectiveTreatment of Kienböck's disease is challenging and the variability of results, despite the surgical technique, shows that there must be other aspects that can influence outcomes. The objective of this study is determine, through arthroscopic approach, the pattern of impairment of the carpal bones in Lichtman stage III patients.MethodWrist arthroscopy was performed in patients with symptoms and evidence of lunate necrosis on x-rays, with signs of 3A and 3B stages. The Outerbridge classification was used to grade the articular status of the carpal bones.ResultsFifteen patients with stage 3 disease were assessed, five of whom were staged as type 3A and ten as 3B using the Lichtman stages. According to the Outerbridge classification, the lunate sulcus was the most affected with means of 2.8 at 3A and 2.9 at 3B. Other areas were significantly less affected with means of 1.1 and 1.3, respectively.ConclusionArthroscopic assessment of the wrist could aid in surgical decision making, offering more details on cartilage status in stage 3 Kienböck's disease. Level of Evidence III, Study of nonconsecutive patients, without consistently applied reference “gold” standard.

Perilunate fracture-dislocations: clinical and radiological results of 21 cases.

Perilunate dislocations and fracture-dislocations are a subcategory of the carpal instability complex. Herein, we report our university hospital experience with this complex injury. The goal of our study was to find predictive factors and quantify the development of arthritis and lunate necrosis. We tried to measure the impact of arthritis on hand function. Between January 2000 and December 2014, 21 patients underwent surgery for perilunate dislocations and perilunate fracture-dislocations of the wrist in our tertiary university center. Mean patient age was 29.3 ± 10.0years (range 18-49years). All displacements were posterior. They were reviewed both clinically and radiologically. Complications included misdiagnosed Essex-Lopresti-like lesion in one case, insufficient reposition of the carpus in two cases (LT in one case, SL in one case), and iatrogenic injury to the radial artery immediately sutured in one case. All 3 cases underwent a second procedure with satisfactory outcome. After a mean follow-up of 112 ± 60months (range 12-210months), the average Cooney score was 80 ± 19 (range 50-125). The mean PRWE score was 10 ± 8 (range 0-25). The mean DASH score was 40 ± 13 (range 30-75months). Mean pain on load, measured with VAS was 1.1 ± 1.6; Clinical examination assessed a mean wrist extension/flexion of 42.4° ± 17.2°/48.4° ± 15.2°. Mean wrist ulnar/radial deviation was, respectively, 22.9° ± 11.3°/15.3° ± 7.0°. Mean pro/supination was, respectively, 75.2° ± 11.5°/76.3° ± 8.1°. Mean pinch strength was 9.4 ± 2.2kg (87.4 ± 17.7% of the contralateral side). Mean power strength was 41.9 ± 9.9kg (76.2 ± 19.2% of the contralateral side). Two patients had a scaphoid non-union identified on their most recent imaging. The mean carpal height ratio was 0.53 ± 0.05 (range 0.44-0.65). All except one patient developed arthritis: Grade 1 in 11 patients, Grade 2 in 3 patients, and Grade 3 in the remaining 6 patients. Age, length of follow-up, and loss of reduction were significantly associated with wrist arthritis (p < 0.001). Lunate avascular necrosis assessed by magnetic resonance imaging was present in 6 patients: Stage 2 in 4 patients, Stage 3a in 1 patient, and Stage 3b in the remaining patient. All these patients' intraoperative findings showed lesion of the cartilage of the radial side of the lunate. However, the small number of patients who developed lunate necrosis did not allow satisfactory statistical analysis. This retrospective study demonstrates good functional results despite the high rate of radiological wrist arthritis. Age, length of follow-up, and loss of reduction were significantly associated with wrist arthritis in our series.

Ligament reconstruction using rivet for treatment of trans-radius perilunar dislocations

Objective To evaluate application of rivet for ligament reconstruction in the treatment of trans-radius perilunar dislocations (TRPD). Methods From February 2007 to May 2014, 9 cases of TRPD were treated. They were divided into three types according to the fracture site: type Ⅰ for dorsal radius, type Ⅱ for radial styloid, type Ⅲ for dorsal radius and radial styloid. All 9 patients were surgical treated using rivet for ligament reconstruction. Patients were evaluated postoperatively by measuring the range of motion of the wrist and grip strength, wrist radiography for fracture healing and signs of post-traumatic arthritis. The Mayo wrist score was assessed. Results There were 4 cases of type Ⅰ, 4 cases of type Ⅱ and 1 case of type Ⅲ. The first radiography diagnosis was inaccurate in 3 cases. Surgical open reduction, internal fixation and ligament repair were carried out in all patients under brachial plexus block. All patients were follow-up for 10 to 26 months with a mean period of 18 months. The final outcome was excellent in 3 cases, good in 4, and fair in 2 according to the Mayo wrist score. The average range of flexion and extension motion was 109.4°and the mean grip strength was 84.2% of the uninjured wrist. Two patients suffered slight pain. Aseptic necrosis of the lunate occurred in 1 case. No post-traumatic arthritis and nonunion were present on X-rays. Conclusion Ligament reconstruction using rivet can achieve a satisfactory outcome for treatment of trans-radius perilunar dislocations. Key words: Dislocations; Treatment outcome; Rivet; Ligament reconstruction

Histopathological Analysis of the Lunate in Rheumatoid Disorders

Introduction: Avascular necrosis of the lunate in Systemic Lupus Erythematous (SLE) and rheumatoid arthritis (RA) are not rare. Our study aimed to describe the histopathology of the lunates after removing them in the operating room in patients with rheumatoid diseases and lunate palmar dislocation. We correlated the histopathological findings with magnetic resonance imaging (MRI), radiological parameters, and blood test parameters. Methods: From January 2006 to January 2015, 12 patients were operated for rheumatoid disorders, 8 RA, 1 SLE, and 3 psoriatic arthritis (PA). There were 8 female and 4 male with a mean age 65 (53-79) years. Antinuclear antibodies and other relevant tests were performed. Anticardiolipin antibody, anti-double-stranded DNA, and anti-β-2 glycoprotein I were measured by enzyme-linked immunosorbent assay (ELISA). All patients underwent MRI study. T1-weighted images were evaluated for bone necrosis of the lunate. In the operating room, we excised whole lunates and we studied the macroscopical aspect inside and outside. We evaluated the size, cartilage surfaces, number of foraminas, and ligament insertions. After that, we cut the bone and showed the bleeding bone and collapse areas. Histopathological analysis was performed with lunate sections. The lunates were fixed in formalin, decalcified, embedded in paraffin, and cut in 5 microm sections, and stained with hematoxylin and eosin. We visualized lunates sections by microscope. The surgical treatment was a wrist arthrodesis in 8 cases and wrist arthroplasty in the other 4 cases. We evaluated x-rays data such as lunate morphology, Stahl Index, Carpal Height ratio (CHR), and Carpal Ulnar distance ratio (CUDR). We correlated preoperative x-rays and MRI data with histopathological findings. We correlated blood test parameters with the histology. Statistical analysis of data was performed with chi-square test (significance level P &lt; .05). Results: In 2 cases, we showed a lunate flattening associated with a partial hypointensity in coronal sections in T1-weighted images in MRI. Microscopic analysis showed synovial hyperplasia, fatty marrow, and fibrovascular tissue. We did not find avascular necrosis in any complete lunate but we found a focal necrosis (empty lacunae) in 2 cases. Mean CHR was 0.385, CUDR 0.301, Index Stahl 56.95, and radio-scaphoid angle 76°. We showed more ulnar translation in RA than in other rheumatoid disorders (CUDR P = .002). The correlation focal lunate necrosis with MRI was P = .371. The correlation focal lunate necrosis with scapholunate ligament rupture was P = .640. We showed 2 blood test parameters statistically significant with focal lunate necrosis (C reactive Protein P = .046 and Rheumatoid Factor P = .053). Conclusion: Neoangiogenesis and wrist synovitis in rheumatoid disorders, with an increased number of synovial cells and vessels, seem to contribute to the progression of autoimmune diseases. It is possible that the patients with rheumatoid wrists have hypervascularity and therefore a chronic adaptation to a decrease number of vessels in the lunate and to ligament injuries. This could avoid to have Kienböck disease in a chronic palmar lunate dislocation in rheumatoid disorders.

A novel nickel-titanium memory alloy arthrodesis concentrator for the treatment of stage IIIb aseptic lunate necrosis (Kienböck's disease).

A novel nickel-titanium memory alloy arthrodesis concentrator for the treatment of stage IIIb aseptic lunate necrosis (Kienböck's disease).

Proximal carpal row carpectomy

Resection of the proximal carpal row, termed proximal row carpectomy (PRC), is performed in order to treat pathologies of the proximal carpal row or radiocarpal joint between the scaphoid and scaphoid facet. It entails the articulation of the capitate and the lunate facet. Lunate necrosis, carpal collapse, joint infection with concomitant intercarpal ligament lesions. Severe cartilage lesions of the lunate facet and the capitate, wrist capsule laxity, rheumatoid arthritis, neuromuscular dysbalance of the wrist-covering soft tissue structures. Dorsal approach to the wrist, incision of the third and fourth extensor compartments, resection and coagulation of the dorsal interosseous nerve, usage of aligament-sparing capsule incision, identification of the proximal carpal row and inspection of cartilage of the lunate facet and capitate, mobilization and excision of the lunate, scaphoid and triquetrum, articulation of lunate facet and capitate is controlled clinically and fluoroscopically, wound closure, application of plaster slabs. Immobilization of the wrist on plaster slabs for 2weeks, removal of sutures after 14days. PRC is asurgical procedure with few complications. Satisfactory range of motion and grip strength could be preserved without limiting function of the upper extremity. Postoperative osteoarthritis of capitate and lunate facet did not correlate with the good clinical outcome.

Biomechanical Comparison of Two Surgical Methods in Treating Stage IIIb Lunate Necrosis

Biomechanical Comparison of Two Surgical Methods in Treating Stage IIIb Lunate Necrosis

Kienbock’s disease following pellet injury to the lunate: A case report

A case of a 32-year-old male soldier with a history of pain in left wrist 15 months after the patient received pellet injuries in a grenade attack firearm injury is presented. Radiography revealed avascular necrosis (AVN) of the left lunate (Kienbock’s disease) with a small metallic pellet embedded in the lunate. We postulate that the AVN may be either due to disruption of the vasculature, mechanical overload or metallosis. To our knowledge, this is the first time a firearm injury resulting in a retained pellet in the lunate has been implicated in Kienbock’s disease.