[Aseptic necroses of the carpal bones]

The most frequent aseptic necrosis in the carpal area is Kienböck's disease, followed by necrosis of the scaphoid and capitate. Necrosis of carpal bones are seen after different conditions as chronic traumatism, cerebral palsy, chemotherapy, as well as deficient vascularisation of the carpus. Varietys of the wrist joint anatomy may contribute to development of Kienböck's disease. The natural course of the disease shows progressive necrosis and bone destruction in adults. However the clinical symptomatology may show a higher degree of variation. Prevention of carpal dissociation seems to be important. Early surgery by vascularisation techniques and retention of the necrotic bone are indicated. In stages III and IV with collapsing deformity, resection-interposition arthroplasty using autologous material, or silastic spacers, have proven to be successful.