[Therapy of lunate necrosis]

Out of the multiple methods for treating Lunatum-malacia the following were used in our hospital: shortening of the radius, pisiform-transposition, cancellous bone graft, tendon interposition arthroplasty, intercarpal arthrodesis, prothetic replacement, wrist arthrodesis and denervation of the wrist. Because of non satisfactory results the conservative treatment was abandoned. The indication for one of the different operative methods depended on the radiological Decoulx-Stage, the profession and the age of the patient and his willingness to cooperate. From 1972-1988 36 patients with Kienböck's disease were treated in the Unfallkrankenhaus Salzburg. 20 were seen with an average follow up of 8.7 years. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius otherwise with the pisiform transposition. The same results could be achieved in intermediate stages although with reservation for the pisiform transposition. Although the other operative methods gave pain relief and an improvement of grip strengths, they showed radiologically a progression of the necrosis. Denervation and wrist arthrodesis are reserved for stage IV. Despite some good results, new operative methods like revascularisation operations of the lunate bone seem promising.