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What is the cure for avascular necrosis?

Friday, 14 September 2007
Answered by: Dr. Mathew Varghese
Consultant Orthopaedic Surgeon and Director,
St. Stephens Hospital,
New Delhi
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Q. I am a 29-year-old male suffering from avascular necrosis of Lunate bone (right wrist). I am currently on Risofos 35 (weekly) and Genitrol capsules (daily). Please suggest a treatment for this.

A.  Avascular necrosis of the Lunate is a relatively uncommon condition. The disease is of unknown origin, but there are several theories. These include theories about injury as a mechanism or anatomical variations in the angles of the forearm bone (radius) or even the length of the ulna, with patients of this problem showing shorter Ulnar bone of the forearm (called negative Ulnar variance). The treatment is essentially empirical and based more on symptoms. Technically, the disease is classified into different categories and one popular classification (Lichtman) divides it into four categories. In the first two, the bone contour is not deformed. In the third stage the bone begins to fragment, and in the final stage the wrist joint shows changes of degeneration and arthritis. There is no known medical treatment. The medicines you are taking are supposed to be useful in loss of vascularity of another bone, that is, avascular necrosis of femoral head. I am not aware of the benefits of this in this problem, but theoretically it may show some benefit. Surgery depends on the stage of the disease. Vascular pedicled bone grafts are supposed to show promising results. Patients showing negative Ulnar variance show some benefit with lengthening of Ulnar bone or shortening of Radial bone. If there are arthritic changes in the wrist, then the patient may need removal of the bones in the wrist (proximal carpectomy) or a fusion of the wrist to reduce pain.

A.  Avascular necrosis of the Lunate is a relatively uncommon condition. The disease is of unknown origin, but there are several theories. These include theories about injury as a mechanism or anatomical variations in the angles of the forearm bone (radius) or even the length of the ulna, with patients of this problem showing shorter Ulnar bone of the forearm (called negative Ulnar variance). The treatment is essentially empirical and based more on symptoms. Technically, the disease is classified into different categories and one popular classification (Lichtman) divides it into four categories. In the first two, the bone contour is not deformed. In the third stage the bone begins to fragment, and in the final stage the wrist joint shows changes of degeneration and arthritis. There is no known medical treatment. The medicines you are taking are supposed to be useful in loss of vascularity of another bone, that is, avascular necrosis of femoral head. I am not aware of the benefits of this in this problem, but theoretically it may show some benefit. Surgery depends on the stage of the disease. Vascular pedicled bone grafts are supposed to show promising results. Patients showing negative Ulnar variance show some benefit with lengthening of Ulnar bone or shortening of Radial bone. If there are arthritic changes in the wrist, then the patient may need removal of the bones in the wrist (proximal carpectomy) or a fusion of the wrist to reduce pain.

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