Analysis of Wrist Morphology Through Hamate and Lunate Bone Variations in Anatolian Population Using Plain Radiography / Análisis de la Morfología de la Articulación Radiocarpiana a Través de las Variaciones de los Huesos Hamato y Semilunar en la Población de Anatolia Mediante Radiografía Simple

SUMMARY: The present study aimed to evaluate wrist (lunate) anatomy in terms of the incidence of lunatum morphology on plain-radiographs among the Anatolian (Turkey) population, accompanied by demographic analysis. We obtained all the patients' data regarding demographical features, diagnosis, and posteroanterior (PA) X-ray imaging. Two radiograph-reviewers repeated the analysis twice, one month later, blinded to their findings before the previous review. The lunatum structure was determined as Type-1 (n:293) and Type-2 (n:207) for each radiograph. Most of the 500 wrists' radiographs [n:293 (58.6 %)] were type-I lunate. The mean age was 36.7±13.3 (range:18-90) years. Sex distribution was as follows: 185 (63.1 %) males to 108 (36.9 %) females. Type-2 lunate was seen in 207 participants (41.4 %). The mean age for type-2 was 41.6±15.2 (18-88) years. 142 (68.6 %) participants were male sex, while 65 (31.4 %) were females. The mean age of subjects with type-I showed a difference with type-II (p=0.007). There was no relationship in terms of sex (p=0.206) between the groups. In the Anatolian region, type-1 lunate was dominant compared to type-2. The incidence rate of lunate type in Anatolian population was similar to the Arab population.

El presente estudio tuvo como objetivo evaluar la anatomía de la articulación radiocarpiana en términos de la incidencia de la morfología del hueso semilunar en radiografías simples entre la población de Anatolia (Turquía), acompañado de un análisis demográfico. Obtuvimos todos los datos de los pacientes con respecto a las características demográficas, el diagnóstico y las imágenes de rayos X posteroanteriores (PA). Dos revisores de radiografías repitieron el análisis dos veces, un mes después, sin conocer sus hallazgos antes de la revisión anterior. La estructura del lunatum se determinó como Tipo-1 (n:293) y Tipo-2 (n:207) para cada radiografía. La mayoría de las 500 radiografías de muñecas [n:293 (58,6 %)] fueron semilunar tipo I. La edad media fue de 36,7±13,3 (rango: 18-90) años. La distribución por sexos fue la siguiente: 185 (63,1 %) hombres y 108 (36,9 %) mujeres. El semilunar tipo 2 se observó en 207 participantes (41,4 %). La edad media para el tipo 2 fue de 41,6±15,2 (18-88) años. 142 (68,6 %) participantes eran del sexo masculino, mientras que 65 (31,4 %) eran del sexo femenino. La edad media de los sujetos con tipo I mostró una diferencia con el tipo II (p = 0,007). No hubo relación en cuanto al sexo (p=0,206) entre los grupos. En la región de Anatolia, el semilunar tipo 1 era dominante en comparación con el tipo 2. La tasa de incidencia del tipo semilunar en la población de Anatolia fue similar a la de la población árabe.

Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.@*METHODS@#One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.@*RESULTS@#The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.@*CONCLUSION@#The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.

Dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius.@*METHODS@#From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation.@*RESULTS@#All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good.@*CONCLUSION@#Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.

Chronic Lunate Dislocation: An Unusual Cause of Carpal Tunnel Syndrome—Avoiding Diagnostic Pitfalls and Synopsis of Management Options

ABSTRACT Carpal tunnel syndrome (CTS) represents the most common compressive neuropathy of the upper limb (1). There are a myriad of causes of CTS, of which carpal fractures and dislocations are known aetiologies. Volar lunate dislocations are the most common carpal dislocations described (1). Approximately 25% of perilunate dislocations are missed on initial presentation, resulting in delayed diagnosis and likely poorer outcomes (1-3). A case of chronic lunate dislocation presenting as CTS is presented here to highlight diagnostic pitfalls and management options.

Correlation between Global Wrist Laxity and Movement of the Scaphoid and the Lunate in Various Places During Radio Ulnar Deviation of the Wrist

Introduction: In the intact wrist, three dimensional motionsof the carpal bones has been reported as a screw displacementaxis representation of the motion as the angular motion ofthe bones or as translations between the bones, however thelatter has frequently been quantified as a displacement in thedirection of the screw axis. Current research aimed to establishcorrelation between global wrist laxity and movement of thescaphoid and the lunate in various places during radio ulnardeviation of the wrist.Material and methods: The proposed study was a prospectivestudy conducted in the Department of Orthopedics, RMCH,Bareilly, UP, comprising 100 healthy volunteers with equal sexration who never had any symptoms pertaining to their wristjoint. An informed written consent was obtained. Standardposterolateral and true lateral radiograph of wrist were madeto exclude any radiological abnormality. PA and lateralradiograph were obtained in full radial and ulnar deviation.A custom-made positioning device was used to ensure properplacement of the hand and wrist during the examination.Results: We observed that the age varied from 21 years to 40years. Radial deviation varied from 10 to 25 degree with meanof 18.06 degree. Ulnar deviation varied from 25 to 60 degreewith mean of 36.51 degree. Laxity score varied from 31 to 100with mean of 64.20.Conclusion: Within the limitations of the present study,it can be concluded that the ulnar deviation of the wrist isseen to cause radial translation ad dorsal rotation of theproximal carpal row. Similarly, the radial deviation was seento cause ulnar translation and volar rotation of the proximalcarpal row.

Luxación palmar divergente del escafoides y semilunar: reporte de caso / Palmar divergent dislocation of the scaphoid and lunate: case report

Reportamos el caso de un hombre de 61 años de edad quien presentó una luxación palmar divergente del escafoides y semilunar de la muñeca derecha secundario a trauma por caída de una escalera en su casa, quien fue atendido a las 24 horas del accidente, se le realizó una resección de los dos huesos (desvascularizados completamente), y se redujo el hueso grande en la fosa semilunar del radio más reparación de la cápsula articular y los ligamentos palmares radiocarpales. Al control del primer año el resultado ha sido satisfactorio, con un buen desempeño de su actividad laboral, y con una congruencia de la articulacion radio hueso grande y estabilidad completa de la muñeca. Nivel de Evidencia: IV

We report the case of a 61-year-old man who presented a Palmar divergent dislocation of the scaphoid and lunate of the right wrist secondary to trauma due to the fall of a ladder in his house, who was seen 24hours after the accident, he underwent a resection of the two bones (completely devascularized), and the Capitate bone was reduced in the lunate fossa of the radius by adding a repair of the joint capsule and the radiocarpal palmar ligaments. After the first year of follow up the result has been broadly satisfactory, with good performance of his working activity, and with a congruence of the Radial-Capitate joint with complete stability of the wrist. Evidence Level: IV

Pathogenesis and clinical treatment progress of Kienbock’s disease / 中国组织工程研究

BACKGROUND: Kienbock’s disease is aseptic necrosis of the lunate bone due to various causes, and its pathogenesis is unknown. Because the soft tissue around the wrist articular surface is small, so it leads to poor blood supply, and the progressive necrosis is irreversible. Early specificity is poor, clinical diagnosis rate is low, and late teratogenicity and disability rate is high. The clinical diagnosis and treatment are complicated, and there are many procedures, but there is no accurate guidance. OBJECTIVE: To review the current research status of mechanism, stage and clinical diagnosis of Kienbock’s disease, to summarize the clinical treatment of Kienbock’s disease in recent years, so as to discuss the clinical efficacy of various programs and provide guidance for clinical diagnosis and treatment. METHODS: A computer-based online search of PubMed and CNKI databases from 1970 to 2019 was conducted. Key words were “Kienbock’s disease, lunate bone, necrosis, mechanism, treatment” in English and Chinese, respectively. About 900 articles were retrieved, and 52 articles eligible for the inclusion and exclusion criteria were included for review. RESULTS AND CONCLUSION: (1) The pathogenesis of Kienbock’s disease is unknown, its etiology is complex, and researchers believe that anatomy and biomechanics, and individual factors are main causes, which still need further research. (2) The Lichtman stage is widely used in Kienbock’s disease classification. The latest breakthrough in arthroscopy is expected to form a new classification standard, which can be diagnosed by X-ray, CT or MRI combined with “triple sign”. It has poor early specificity, so the rate of misdiagnosis is high, and it should be identified with wrist diseases. (3) Early-stage Kienbock’s disease usually receive conservative treatment, and advanced stage tends to undergo surgical programs, including free vascularized bone graft, the lumate resection + tendon tamponade, radial wedge and shortening osteotomy, scaphotrapeziotrapezoid fusion, proximal row carpectomy, and bone cement prosthesis replacement, and the follow-up outcomes are different, so there is still no perfect treatment program.

Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique / 中国修复重建外科杂志

Objective: 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. Methods: 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. Results: 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 ( P0.05). 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 ( P0.05), 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). Conclusion: 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.

Staging and treatment of traumatic simple Kienb(o)ck's disease / 中华创伤杂志

Aseptic necrosis of lunate bone (Kienb(o)ck's disease) is a comnon cause of wrist pain in clinic.After more than a century of research,although progress has been made in the etiology,pathogenesis and clinical treatment of lunar bone aseptic necrosis,its pathogenesis remains unclear.At present,it is generally believed that the blood supply destruction of lunar bone due to trauma is one of the causes for aseptic necrosis of lunar bone.Treatnent varies according to different classifications,yet without unified or clarified therapeutic regimen.Wrist arthroscopy is a new method for Kienb(o)ck's disease.This article reviews the different stages and treatment methods of traumatic simple Kienb(o)ck's disease,providing reference for clinical treatment.

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

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Percutaneous elevation of depressed lunate fossa: A surgical technique / 中华创伤杂志(英文版)

Die-punch fractures or impaction fractures of distal radius articular surface are difficult to treat and hard to achieve satisfactory reduction. We present a unique, percutaneous and minimally invasive technique to elevate the depressed lunate fossa and maintain the reduction of the elevated fragment with no need of grafting in such fractures. This technique is simple, reproducible and can be executed with simple instrumentations. We think it deserves a variety of implications in the treatment of distal radius fractures.

Manipulative reduction and plaster external fixation for the treatment of the scaphoid fracture and perilunate dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the efficacy and complications of manual reduction and external fixation for the treatment of scaphoid fractures and perilunate dislocations.</p><p><b>METHODS</b>From January 2009 to January 2013, 43 patients suffered from scaphoid fractures and perilunate dislocations were retrospective analyzed. Among them, 17 cases were treated with manipulative reduction and plaster external fixation as conservation group including 10 males and 7 females, the other 26 cases were treated with application of surgical as operation group including 15 males and 11 females. The clinical effects were assessed by Cooney function score, radiological analysis and observation of complications.</p><p><b>RESULTS</b>All patients were followed up for(45.00±8.72) months ranging from 36 to 60 months. At the final follow-up, the Cooney score of wrist function was 88.53±4.24 in conservation group and 89.58±4.59in operation group(0.455, >0.05). During the follow-up, 4 patients were found scaphoid avascular necrosis in the imaging performance in the conservation group(χ²=4.32, <0.05). The difference of other complications between two groups was not statistically significant(>0.05).</p><p><b>CONCLUSIONS</b>For patients suffered from the scaphoid fractures and perilunate dislocation, the early manipulative reduction and plaster external fixation after injury as soon as possible is necessary. Maintaining a satisfactory reduction and reliable fixation at the same time can lead to good treatment effect and there's no weakness compared to surgical treatment. But there was an increase in danger of complications. The key of conservative treatment lies in early diagnosis and maintenance of reduction, reliable fixation, and timely and appropriate functional exercise.</p>

Isolated Symptomatic Scapho-Lunate Coalition without Accompanying Anomalies / 대한정형외과학회잡지

A carpal coalition that indicates the fusion of two carpal bones resulting from the failure of differentiation is a rare condition compared to the tarsal coalition. The most common carpal coalition is the luno-triquetral coalition, followed by the capitate-hamate coalition. Most of these coalitions are usually asymptomatic. Thus far, only a few cases of a coalition between the scaphoid and lunate with accompanied anomalies in the ipsilateral hand, such as accessory carpal bone or ray deficiency, have been reported. We present, for the first time, a case of a symptomatic isolated scapho-lunate coalition without any accompanying anomalies.

Advanced Pediatric Kienbock's Disease / 대한정형외과학회잡지

Kienbock's disease is very rare in pediatrics. The treatment of Kienbock's disease is controversial and depends on an understanding of the natural history of the disease. The methods proposed vary from conservative treatment to surgical treatment such as radial shortening or scaphotrapezoidal joint fixation, but there are few therapeutic guidelines for paediatric Kienbock's disease. We encountered a 14-year-old male with Lichtman stage IIIB disease and treated him with conservative management. We report this rare case of advanced paediatric Kienbock's disease with good clinical results at the 2-year follow-up along with a review of the relevant literature.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft / Capsulodese dorsal associada à reconstrução assistida por artroscopia do ligamento escafossemilunar com enxerto do tendão do músculo palmar longo

ABSTRACT OBJECTIVES: To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. METHODS: From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. RESULTS: The follow-up time was 12 months (3-17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1-6). DASH was 6.50/100 (1-30). The time to work return work was 4.42 months (2-17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities. The preoperative SL gap was 4.29 mm (2-7); in the postoperative period, it was 1.79 mm (1-4). The DISI deformity was present in ten patients with SL angle > 70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. CONCLUSION: The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

RESUMO OBJETIVOS: Mensurar a qualidade de vida, o tempo de retorno ao trabalho, os resultados clínicos, funcionais e radiográficos dos pacientes submetidos à capsulodese dorsal associada à reconstrução ligamentar escafossemilunar assistida por artroscopia. MÉTODOS: De janeiro de 2015 a setembro de 2016, 14 pacientes, esqueleticamente maduros, adultos, com dissociação escafolunar (SL), foram submetidos ao tratamento cirúrgico com o procedimento de reconstrução do ligamento escafossemilunar assistido por artroscopia com a nova técnica proposta neste estudo. Todos os pacientes foram avaliados pelo setor de terapia ocupacional em intervalos regulares de pós-operatório e fizeram a mesma sequência de reabilitação. Os parâmetros analisados foram: arco de movimento (ADM), Disability Arm, Shoulder and Hand (Dash), escala visual analógica (EVA) e análise radiográfica pré e pós-operatória para visualizar o espaço escafolunar (sinal de Terry-Thomas) e deformidade em Dorsal Intercalated Segment Instability (DISI) pré e pós-operatória. Descrição das complicações e o tempo de retorno ao trabalho. RESULTADOS: O tempo de seguimento foi de 12 meses [3-17]. O ADM foi em média 321,07° (96,9% do lado normal). O valor da avaliação subjetiva da dor (VAS) foi 1,79/10 [1-6]. A mensuração da qualidade de vida pelo Dash foi de 6,50/100 [1-30]. O tempo de retorno ao trabalho foi de 4,42 meses [2-17]. Quanto às complicações, uma paciente evoluiu com SLAC e foi submetida à artrodese dos quatro cantos um ano após a reconstrução ligamentar. Evoluiu com melhoria da dor e está com o ADM do punho funcional, mas ainda não retornou às atividades profissionais. O intervalo do SL (gap) pré-operatório foi de 4,29 mm [2-7] e o pós-operatório foi de 1,79 mm [1-4]. A deformidade DISI estava presente em dez pacientes, com um ângulo SL acima de 70° (pré-operatório), e foi corrigida após a cirurgia em todos os pacientes. SLAC estágio I foi identificado em um paciente. A artroscopia foi feita em todos os casos. A instabilidade SL foi classificada como um grau Geissler III em quatro casos e grau IV em dez casos. CONCLUSÃO: A nova abordagem (capsulodese dorsal associada à reconstrução ligamentar escafossemilunar assistida por artroscopia) apresentada neste estudo é segura e eficaz no tratamento da dissociação escafolunar, já que apresenta resultados radiográficos, clínicos e funcionais satisfatórios, demonstra baixas taxas de complicações, permite o retorno às atividades sociais e profissionais e aumenta a qualidade de vida desses pacientes.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture / Ruptura espontánea de los tendones extensores de los dedos de la mano en una fractura oculta del semilunar

Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Microstructure Study of Normal Lunates with Micro-computed Tomography / 华中科技大学学报（医学）（英德文版）

In order to study the microstructure characteristics of normal lunate bones,eight fresh cadaver normal lunates were scanned with micro-computed tomography.High-resolution images of the micro-structure of normal lunates were obtained and we analyzed the nutrient foramina.Then nine regions of interest (ROI) were chosen in the central sagittal plane so that we could obtain the parameters of trabecular bones of ROIs.The distal lamellar-like compact structure had statistically significant differences when it was compared with the ROIs in the volar and dorsal ends of the distal cortex.The difference of diameter between the volar and dorsal foramina was significant (P＜0.05).However,there was no significant difference regarding the number.The trabecular bones of the volar and dorsal distal ends had lower intensity than those of the distal central subchondral bone plate.The diameters of the nutrient foramina on the volar cortex were larger than those on the dorsal.This research provided more detailed information about microstructure of normal lunate and the nutrient foramina on cortex,and a reference for further study about diseased lunate.

Perilunate Injury Combined with Lunate Fracture

We present an atypical case of combined comminuted lunate fracture and the scaphoid waist fracture, chip fracture of triquetrum and pisiform. Comminuted scaphoid waist fracture was caused by forced hyperextension of the wrist, similar mechanism to stage I of progressive perilunate instability (PLI), and lunate fracture might be caused by axial compression force, does not appear on the original theory of PLI. We performed closed reduction and screw fixation for the scaphoid fracture and immobilized and mildly distracted the wrist joint with the use of a bridging external fixator to prevent further collapse of comminuted lunate by neutralizing the compression force imposed by the capitate on the lunate. We achieved excellent radiological and clinical outcomes at 29-months of follow-up. We aimed to introduce this rare injury and clinically important points in its treatment with the review of the literature.

Ultrasonography Detected Missed Lunate Volar Dislocation Associated With Median Neuropathy: A Case Report

Lunate and perilunate dislocations are uncommon, but they have clinical importance because complications, such as median neuropathy and avascular necrosis of the lunate, can occur. Although early diagnosis enabling early surgical treatment is crucial for preventing long-term sequelae, these dislocations are frequently missed in the initial assessment. Imaging tools, such as plain radiography, magnetic resonance imaging, ultrasonography, and electrodiagnostic studies, have been used for diagnosis. The proper choice of initial evaluation tools is important for making an accurate early diagnosis. Here we present a case of lunate dislocation associated with median neuropathy in which ultrasonography, along with the electrodiagnostic study and plain radiography, played an important diagnostic role in detecting structural abnormalities. This case report reveals the complementary diagnostic role of ultrasonography in initial assessment and provides ultrasonographic images of lunate dislocation as a cause of median neuropathy.

Morphology and morphometry of the distal articular surface of lunate bone in a Kenyan population / Morfología y morfometría de la superficie articular distal del hueso semilunar en una población de Kenia

The morphology and morphometry of the distal articular surface of the lunate exhibits inter-population variations. They are of clinical importance to hand surgeons due to their influence on the occurrence of proximal pole arthrosis which is a cause of ulnar-side wrist pain. The objective of the study was to determine the morphology and morphometry of the distal articular surface of the lunate bone in an adult Kenyan population. A descriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi. Fifty-six human hands obtained for routine dissection were used. The morphology of the distal articular surface of the lunate was classified as either Type I or Type II depending on the absence or presence of a medial facet for articulation with the hamate respectively. The width of the wrists and of the medial facet in Type II lunates was measured with SOMETTM CN-25 1234 vernier calipers (accurate to 1mm). Photomacrographs of representative lunate were taken. Data were analyzed using SPSS version 17.0. The Pearson correlation test was used to check for any correlations. Type II lunate morphology was more common with a prevalence of 34 (61 %) while 19 (34 %) were Type I. The mean width of wrists with Type I lunate was 41.1±2.8 mm while those with Type II had a mean width of 46.1±4.3 mm. The mean width of the medial facet in lunate type II was 4.4±1.4 mm. Lunotriquetral fusion was demonstrated in 3 (5 %) wrists. Prevalence of Type II lunate was higher than Type I. Wrists with a Type II lunate were wider than those with Type I. There was no correlation between the width of the wrist and the width of the medial facet of the lunate.

La morfología y morfometría de la superficie articular distal del hueso semilunar muestra variaciones entre la población. Es de importancia clínica para los cirujanos de mano debido a su influencia en la incidencia de la artrosis del polo proximal, que causa dolor ulnar en la muñeca. El objetivo fue determinar la morfología y morfometría de la superficie articular del hueso semilunar en una población adulta de Kenia. Estudio descriptivo de corte transversal, realizado en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se utilizaron 56 manos humanas que fueron sometidas a disección de rutina. La morfología de la superficie articular distal del hueso semilunar se clasificó en Tipo I o Tipo II en función de la ausencia o presencia de una faceta medial de la articulación. El ancho de las muñecas y de la faceta medial en el Tipo II se midió con el caliper SOMETTM CN-25 1234 (precisión de 1 mm). Se tomaron macrofotografías representativas del hueso semilunar. Los datos fueron analizados con el programa SPSS versión 17.0. Se utilizó la prueba de correlación de Pearson. La morfología del hueso semilunar Tipo II fue más frecuente con una prevalencia de 34 casos (61 %), mientras que 19 casos (34 %) eran de Tipo I. El ancho promedio de las muñecas del hueso semilunar Tipo I fue de 41,1±2,8 mm, mientras que las de Tipo II fue de 46,1±4,3 mm. El ancho promedio de la cara medial del hueso semilunar Tipo II fue de 4,4±1,4 mm. Se demostró fusión semilunar-piramidal en 3 casos (5 %). La prevalencia del hueso semilunar Tipo II fue mayor que la del hueso semilunar Tipo I. Las muñecas que presentaban hueso semilunar Tipo II fueron más anchas que las de Tipo I. No hubo correlación entre el ancho de la muñeca y el ancho de la faceta medial del hueso semilunar.