"The Disease you never hear off or you have never heard off, until you get it".......( Col Pickering )

Avascular Necrosis of the Lunate

n: osteochondrosis affecting the lunate bone - called also lunatomalacia.

Basically, the blood supply to the lunate bone shuts off, which causes the bone to die, with eventual collapse of the lunate bone.

As this is a RARE DISEASE little is known about its causes.

KIENBOCK ROBERT ( 1871-1953 ) Austrian Radiologist.

Kienbock pioneered in Radiology. From 1910-1911 he published descriptions "Concerning Traumatic Malacia of the lunate and its Consequences : Degeneration and Compression Fractures", descriptions of dislocations of the hand and a slowly progressive Chronic Osteoitis involving the Lunate Bone.

Kienbock described the process of Lunatomalacia both the Radiographic changes seen with the disease, and the clinical symptomatology that accompanied it.

Radiographically, Kienbock described various changes in the lunate with the vast majority of cases beginning the disease in the proximal portion, preserving the distal portion articulating with the capitate. In some radiographs, the shape of the lunate was preserved and only the internal structure was altered, with radiographs demonstrating areas of increased intensity. In most radiographs, however, with the progression of the disease, the shape of the lunate was significantly affected with the destruction of the proximal portion and loss in height of the bone.

Kienbock noted that the disease usually occurred in men in their thirty's and forty's who were heavy labourers. Frequently they would have an antecedent trauma with negative radiographs and were diagnosed with a sprain. Overtime, the clinical course would progress with pain, swelling and restricted motion of the wrist. Percussion of the third metacarpal ( the hand held in a fist ) produced pain in the lunate region and when comparing hands shortening of the carpus might be evident.

Radiographs demonstrated radiographic changes in the lunate and loosening of the radiocarpul joint, which Kienbock thought promoted mechanical damage. This loosening probably referred to the increased radiocarpul space due to synovitis, proceeding radiocarpul arthrosis.

Kienbock favoured the view that the condition was due to a disturbance in the nutrition of the lunate, caused by a rupture of the ligaments from a sprain or sublixation. Leading to, rather than being a result of compression fractures.

Kienbock believed that recovery from this disturbed nutrition only occurred in acute cases, and in late cases, it could be treated only by removal of the lunate.

Usually at surgery or on a post mortem examination, the lunate was found in two fragments, as previously described by anatomist's, one volar and one dorsal.

Now known to be 'Kienbock's Disease'

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