[The spontaneous course of lunate malacia]

The analysis of 114 cases of lunatomalacia illustrates well the natural history of Kienböck's disease. The investigation encounters some difficulties in that the patients have all been treated, whether surgically or not, at different stages of the disease. Thus, lunatomalacia's otherwise spontaneous course has been influenced in one way or another. Although we cannot present cases in which all stages of lunatomalacia can be traced, we have been able to gain valuable insights from our analysis: A remission is possible in the early stage of lunatomalacia. Severe clinical symptoms present upon lunate collapse and particularly upon development of pronounced arthritic changes. One to two years elapse before lunate collapse, whereas the development of arthrosis of the wrist may take from ten to twenty years. Lunate disintegration is followed by carpal collapse, after which clinical symptoms subside. A new staging for lunatomalacia is presented, taking clinical, radiological, biomechanical, and therapeutic aspects into account.