title: A Three-Dimensional Micro-Computed Tomographic Study of the Intraosseous Lunate Vasculature: Implications for Surgical Intervention and the Development of Avascular Necrosis.
abstract: BACKGROUND
  The purpose of this study was to use micro-computed tomography to demonstrate the intraosseous vascularity of the lunate within a three-dimensional orientation to identify areas of greatest perfusion and define vascular "safe zones" for surgical intervention.
  
  
  METHODS
  Fourteen upper extremities were injected with a lead-based contrast agent. The lunates were harvested and scanned using a micro-computed tomography scanner. The intraosseous vascularity was incorporated into a three-dimensional image. Vessel number, diameter, distribution, and pattern were evaluated and analyzed. Vascularity of all specimens was projected onto one representative lunate to identity areas of higher and lower vascularity.
  
  
  RESULTS
  Twelve specimens had nutrient vessels entering the bone from volar and dorsal; two specimens had no dorsal vessels. The intraosseous vascularity could be classified according to the Y, I, and X patterns described by Gelberman et al. Average number and diameter of vessels were 2.3 and 118.1 μm, respectively, for volar; and 1.4 and 135.8 μm, respectively, for dorsal. The long axis of the lunate showed the highest vascularity on both axial and lateral views. Lower vascularity was observed in the dorsoradial and volar-ulnar quadrants on the axial view, and in the proximal part on the lateral view. Lunate shape was not associated with an increase or decrease in nutrient vessels or vascular pattern.
  
  
  CONCLUSIONS
  Vascular safe zones were identified, allowing for potentially safer surgical interventions to the lunate. Volar approaches to the lunate may result in localized ischemia in a subset of patients with absent dorsal nutrient vessels. This study may help to better define patients at risk for Kienböck disease.
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Nick A
authors: NA
authors: van Alphen
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Mohamed
authors: M
authors: Morsy
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Alexis T
authors: AT
authors: Laungani
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Assaf
authors: A
authors: Kadar
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Andrew J
authors: AJ
authors: Vercnocke
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Nirusha
authors: N
authors: Lachman
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Erik L
authors: EL
authors: Ritman
authors: Rochester, Minn.; and Assiut, Egypt.|From the Division of Plastic Surgery, Department of Surgery, the Departments of Physiology and Biomedical Engineering and Anatomy, Mayo Clinic; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.
authors: Steven L
authors: SL
authors: Moran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D012667:Lunate Bone / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D055114:X-Ray Microtomography