Abstract

In 1910 Kienboeck described for the first time the characteristics of lunatomalacy. Concerning the aetiology of the disease there is an uncertainty about the cause-effect relation between the trauma and the necrosis of the semilunar; several aetiological theories have been supposed. There is not really a correlation between the clinical symptoms and the extent of the radiographic alterations. In this work I report the case of a boy aged 16 affected by Kienboeck disease, practicing karate, who underwent the resection and the shortening of his radius. The patient had a trauma at his right wrist about one year before our checking. Clinical examination pointed out a restriction on the width of the movements of the wrist with a dorsal tumefaction. He underwent an osteosynthesis of his radius with removal of a clinical portion of the radius about 3 mm wide, an osteosynthesis in compression was applied by at plaque. The radiography show a vascular necrosis of the semilunar and an increased bony density, this case has been classified as II-III of Lichtam. The radiographies made five months after the operation show the presence of a bony corn with neoapposition. There was a good functional recovery. Many authors prefer this technique. It avoids a second incision. The metaphyseal seat, where the osteotomy of 3-5 mm is executed consolidates very fast. The firm osteosynthesis allows a precox mobilization. This technique normalizes the distribution of the load on the radiolunata articulation, reduces considerably the compressing loads on the semilunar reducing, besides, also the tension of the muscles which cross the articulation without altering the tension of the intermetacarpal ligaments. Probably reducing the forces that concentrate on the articular surface, the vascularization of the semilunar bone is helped and so is its recovery. The patient here described is not the youngest case ever described, in fact other colleagues have already described the case of a patient 10 years old. Verf.-Referat