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Simultaneous Avascular Necrosis Of The Lunate And Scaphoid
Edward Ruane, Benson Pulikkottil, and Joseph Imbriglia
University of Pittsburgh Department of Plastic Surgery
2017-02-15
Presenter: Edward J Ruane, Jr, MD
Affidavit:
All of the work on this project represents original work by Ed Ruane.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Pathologies of the scaphoid and lunate are a common cause of wrist pain. Individually, Kienböck's disease and Preiser's disease are described in the literature with a multitude of potential treatment options. Simultaneous avascular necrosis of these carpal bones is a rare entity.
Methods: We report a case of a 60-year-old female smoker with right-sided avascular necrosis of both the scaphoid and lunate with a prior history of systemic steroid usage. Through this case, we elucidate and offer potential solutions for this rare but challenging problem facing hand surgeons.
Results: The patient underwent a proximal row carpectomy. Postoperative radiographs revealed satisfactory positioning of the capitate in the lunate fossa with no impingement upon radial deviation. By just four months postoperatively, she showed great improvement in wrist function with active 25° extension and 40º flexion. This represents a 20°-improvement in extension and 30º-improvement in flexion.
Conclusion: Proximal row carpectomy provides a reliable treatment alternative for this unusual problem.
