Interview

What causes lunate necrosis?

The causal starting point for the development of avascular necrosis of the lunar bone is still unknown: The following factors are now assumed to be predisposing factors:

Already in 1910 Kienböck (LN also known as Kienböck desease) pointed out possible damage to the nourishing vessels of the lunar bone. Since the dominant extremity is preferably damaged, recurring injuries are assumed to be the cause of the occlusion of the small vessels. The recognition of the LN as an occupational disease z. B. in patients who have worked with heavily vibrating machines for more than 3 years.

In 1947, Stahl assumed a one-time wrist trauma with a fracture of the lunate as the trigger for the LN; this theory is rejected by most authors nowadays, since the fracture occurs rather as a secondary phenomenon in the natural course of the LN. In addition, in a study by Mirabello et al. In 1987, trauma could be identified in 40%, but in no case a lunate fracture was found to be the cause of LN.

Finally, similar to the development of Fermur's head necrosis, venous outflow disorders have recently been discussed as a possible cause (Schiltenwolf 1996). Intraosseous pressure measurements showed significant differences here, especially in the extended position of the wrist.

The observation of Hulton in 1928, who found lunate necrosis to be more frequent in connection with a variant of the ulnar nerve, namely in 62-78% of all cases, has therapeutic consequences. Due to the inadequate ulo-lunar force transmission, the lunar bone in the radiolunar compartment is exposed to an increased axial load. It is also known that variations of the unaminus are often associated with a triangular malformation of the lunar bone (Amadio / Taleisnik 1993). Due to this malformation with a reduced contact surface to the radius and the trabecular arrangement, this form is said to have an increased tendency to necrosis.

Is LN Hereditary?

There is no knowledge of "inheritance" of the LN. It is the same with manually active patients who do not have the vibration trauma described above, unless the above-mentioned level difference with ulnar nerve variant is present.

Can LN be due to any environmental influences?

Environmental influences do not seem to have a pioneering influence on the development of LN, if one excludes the nagative effects of nicotine on the entire vascular system.

Does LN compare to osteoporosis?

A comparison of LN with osteoporosis is not possible, here we are dealing with completely different clinical pictures, even if sometimes with similar symptoms (pain, restricted mobility) The same applies to sympathetic reflex dystrophy - formerly known as Sudek's disease - there are none here Comparability. The German Society for Hand Surgery (DGH) has developed a guideline for the LN in a consensus finding under the coordination of Prof. Dr. med. Margot C. Wüstner Hoffmann from Ulm, a copy of which I gave you at your last interview.

Comment from the webmaster: See also the Diagnostics section on the content of the guideline. The guideline was officially adopted in 2005. I also got this information from the start. Since there are not yet any new guidelines of the DGH, no agreement has been reached so far that specifies a clear treatment of lunate malacia according to given rules! Job or career choice at LN, what should you consider?

With regard to the choice of job and occupation, occupations that place a heavy load on the radial wrist or are associated with strong vibrations in the wrist should certainly be left out. A "career-finding internship" is certainly a good idea before choosing a career.

How do you recognize a good hand surgeon who is familiar with the LN?

Recognizing a "good" hand surgeon as a patient is not easy. However, some things should be true:

Recommendations from other patients who have been successfully treated cannot be dismissed out of hand. As with any choice of doctor, the trust that you have in the treating doctor plays a decisive role in the success or failure of a therapy. This is essential in surgical areas necessary distance and real assessment of one's own actions. Beware of colleagues for whom any interventions are "no problem" or who pretend to have carried out all operations "a thousand times". Internet presentations or press releases (Spiegel / Focus) can only be used to a limited extent when choosing the future Help the practitioner.

End of the interview. Only genuine with the signature of the webmaster ...

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