Post-Traumatic Lesions of the Lunate Bone

Abstract

Of injuries to the wrist bones, navicular fractures are the most common, followed by lesions of the lunate bone (Bauendam, Cave, Jensen, Kappis) . The pathologic change that is variously termed Iunatomalacia, Kienbock’s disease, post-traumatic malacia, chronic osteitis, and aseptic necrosis has been the subject of comprehensive studies since the end of the last century, when anatomists described such lesions under the designations lunatum partitum, bipartitum, epilunatum, etc. Of the theories propounded regarding the mechanism of origin, four different categories may be distinguished. (1) Axhausen’s theory differs essentially from the others in that he discounts the notion of a traumatic etiology and believes the cause to lie in an aseptic embolus of unknown origin. All other investigators attach major or minor significance to traumata.-(2) Kienbock, who in 1910 described in detail the symptomatology and roentgenologic picture of lunatomalacia, attributed the condition to ruptured ligament and vascular injuries attendant upon dorsal subluxation of the semilunar bone. The vascular disturbance, in his opinion, gave rise to malacia of the bone, and subsequent traumata resulted in compression and fragmentation. Opponents of Kienbock’s theory have asserted that dislocation of the lunate bone is never followed by malacia (Hulttn and others) and that ligament ruptures are not demonstrable at microscopic examination of malacia (Fabricius-Moiler, Cordes) .-( 3) Muller, in 1920, advanced a theory according to which minor traumata lead to pathologic processes of obscure character. This theory was based on the fact that the disease most commonly affects the right hands of manual workers. Although a few other investigators have subscribed to Muller’s theory (Gocke, Esau and others) the majority believe that a compression fracture is primary.-(4) The fracture theory fortified by the results of microscopic