[Traumatic etiology of Kienboeck's disease. (Perilunate subluxations and semilunate necrosis)].
The authors have studied the incidence of lunate necrosis in 110 perilunate dislocations. Twenty-one cases (19%) developed a necrosis. The classification into three types, according to the amount of damage to the perilunar ligaments, is of prognostic value. There is no risk of necrosis in type 1, 17% in type II, and 50% in type III. An associated fracture of the scaphoid does not modify the risk. In neglected lesions, reduction of the lunate dislocation should be attempted, even at a late date, the risk of necrosis then being 50%. Surgical reduction increases the risk of secondary necrosis to a greater extent than does orthopedic treatment, but it is generally use in the most complex cases too. The authors advocate a closed reduction with percutaneous pin fixation.
Lesire
M R
MR
Département de Chirurgie Orthopédique et Chirurgie de la Main, Hôpital Saint-Charles, Montpellier.
Allieu
Y
Y
Bonnel
F
F
Caron
M
M
Dossa
J
J
Dunaud
J L
JL
Duparc
J
J
Humblet
P
P
Michon
J
J
D000293:Adolescent; D000328:Adult; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000145:classification / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000145:classification / Q000150:complications* / Q000601:surgery; D012667:Lunate Bone / Q000293:injuries*; D010007:Osteochondritis / Q000209:etiology*; D010020:Osteonecrosis / Q000145:classification / Q000150:complications* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome