[Stress osteotomy of the distal radius- and ulna metaphysis (Illarramendi procedure): an alternative treatment method in lunate necrosis].
The etiology of Kienböck's disease is still unknown. Many operative procedures, usually based on biomechanical considerations, are recommended. Based on known effects of core decompression procedures on bone, we present a technique of core decompression of the metaphysis of the distal radius and ulna (MCD) as an easy, alternative biologic treatment. Ten cases with a mean follow-up of 10.8 years are analyzed. All patients had significant postoperative pain relief and returned to their previous activities. At the time of follow-up, comparative motion of flexion-extension of the wrist averaged 74%, mean grip strength was 81% of the nonaffected side. Radiographic follow-up did not slow significant postoperative collapse of the lunate (p > 0.05). No correlation was observed between post-operative results and ulnar variance. MCD is a simple, low-risk procedure. Clinical and radiological outcome supports a theory of biologic rather than biomechanic mechanisms related to fracture healing, that stimulate regeneration of the avascular lunate and relieve symptoms. A primary vascular etiology of idiopathic avascular necrosis of the lunate seems to be likely.
Staatlich Orthopädischen Klinik München.
C
C
Schulz
P
P
De Carli
H
H
Anetzberger
A
A
Illarramendi
D000328:Adult; D001861:Bone Regeneration / Q000502:physiology; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010007:Osteochondritis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000601:surgery